Relationship between Elevated Liver enzymes and Metabolic syndrome among Egyptian adults

Background and study aim: Liver enzymes are important markers for hepatocyte damage. Metabolic syndrome (MS) is a combination of metabolic abnormalities including high blood glucose, obesity, hypertension and dyslipidemia. The incidence of MS is believed to be increasing in Egypt. The purpose of this study is to examine the relationship between elevated liver enzymes and MS among Egyptian adults. Patients and Methods: A total 138 apparently healthy subjects were randomly included (99 females and 39 males). Demographic, clinical (blood pressure, body mass index and waist circumference) and biochemical (measurements of alanine aminotransferase (ALT), aspartate amino-transferase (AST), alkaline phosphatase (ALP), lipid profile, blood glucose and viral markers) were collected from every subject. Metabolic syndrome was defined according to a well-known criteria and subjects in the final analysis were divided into group I; metabolic syndrome and group II; non-metabolic syndrome subjects. Results: In this study, 92 persons fulfilled three of the five criteria of metabolic syndrome (group I) with prevalence of 66.7% while group II (non-metabolic syndrome) represented 33.3%. Patients with MS were older and less physically active in comparison with group II. There were an association between elevations in liver enzymes (ALT, AST, ALP) and MS. ALT, AST and ALP were elevated in 42.4%, 17.2% and 20.7% of patients with MS respectively. ALT and AST showed positive correlation with elevated blood glucose and triglycerides levels while AST/ALT ratio showed negative correlation with diastolic blood pressure, triglycerides level and waist circumference. The more items of MS the patient have the higher the level of liver enzymes. Conclusion: Among Egyptian adults elevated levels of liver enzymes were associated with MS and a correlation was noticed with its components

Strain-strain rate imaging of impaired left atrial function in patients with metabolic syndrome

Background: Metabolic syndrome (MS) predisposes to left ventricular dysfunction and heart failure, however, alterations in left atrial (LA) function in MS are unknown. Objectives: We aimed to use strain/strain rate (SR) imaging to investigate the effect of MS on LA function. Subjects and Methods: This prospective case control study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched apparently healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of LA function by speckle tracking. Partial correlation and multiple stepwise regression analyses were used to determine the risk factors for impaired LA function. Results: Compared with the controls, the MS patients showed significantly lower levels of mean strain, mean peak systolic SR and mean peak early diastolic SR (P<0.05 for all), with no difference in the mean peak late diastolic SR. Central obesity, hypertension, dyslipidemia and uncontrolled diabetes were independent risk factors for impaired LA function. Conclusion: SR imaging is reliable in assessing LA function in MS patients

Metabolic syndrome components correlation with colorectal neoplasms: A systematic review and a meta-analysis

Background : Patients with metabolic syndrome (MetS) have a higher risk of developing colorectal neoplasms (CRN) including colorectal adenoma (CRA) and colorectal cancer (CRC). Nonetheless, the role and implication of each component of the syndrome, i.e. (hyperglycemia, hypertension, dyslipidemia, and visceral obesity) are not well ascertained. Aims: We conducted a systematic review and a meta-analysis in order to assess the association between MetS components and CRN. Methods and Material: A systematic literature search using the PubMed database was performed with the objective of identifying relevant English studies. Effect estimates were measured. Heterogeneity, subgroup, sensitivity analyses, and publication bias analyses were performed. Results: Thirty-one studies met our inclusion criteria. Generally, subjects with hyperglycemia (RR = 1.33; 95% CI 1.14-1.54), high waist circumference (RR = 1.30; 95% CI 1.19-1.42), high triglycerides (RR = 1.30; 95% CI 1.13-1.49), and hypertension (RR = 1.26; 95% CI 1.17-1.36) showed a stronger positive significant association with CRA formation risk. A similar pattern was found between high fasting blood glucose (RR = 1.35; 95% CI 1.23-1.47) and high blood pressure (RR = 1.28; 95% CI 1.20-1.37) with CRC incidence. A moderate association was found between hypertriglyceridemia and visceral obesity with CRC risk. Conversely, no significant association was found between low high-density lipoprotein-cholesterol (HDL-C) with both outcomes. Conclusions: Our results indicate that hyperglycemia, hypertension, visceral obesity, and hypertriglyceridemia increases CRA and CRC risk. Low HDL-C has no significant effect on those outcomes

The Metabolic Syndrome in an Elite African Community

Metabolic syndrome is a combination of metabolic disorders which increase the risk of developing cardiovascular disease and type 2 diabetes; two common causes of morbidity and mortality all over the world; with increasing incidence in sub-Saharan Africa. This study was carried out to determine the prevalence of metabolic syndrome in an elite Nigerian community and determine independent predictors of the condition. A cross-sectional study was designed involving 200 members of the community. They responded to a structured questionnaire on their demographic parameters as well as medical and drug histories. Fasting blood glucose; triglycerides; LDL-cholesterol; HDL-cholesterol and Total cholesterol were measured. Blood pressure; BMI and waist circumference were also measured. Using the IDF definition i.e presence of central adiposity and two of raised TG (?1.7 mm/L); reduced HDL (1.03 mm/L in men and 1.29 mm/L in women); raised blood pressure (130 mmHg systolic or 85 mmHg diastolic; or an antihypertensive drugs); and raised fasting blood glucose (5.6mm/L or previously diagnosed type 2 diabetes); a total of 35 persons were found to have metabolic syndrome. The commonest lipid abnormality found was reduced HDL levels. Raised BMI was a strong predictor (18). The study shows that while the prevalence of metabolic syndrome is low in the community; a large number of people have central obesity and high BMI. It is important for stakeholders to create awareness on the need to keep fit. There is also a need to carry out more studies on independent determinants of metabolic syndrome and seek to understand the pathways by which it develops; so as to be able to address it's far reaching implications

Coronary Endothelial Dysfunction; Obesity and the Metabolic Syndrome

Objective : To define the impact of the metabolic syndrome (MetS) and obesity on coronary vascular function; with the hypothesis that subjects with MetS will have endothelial dysfunction. Background : Obesity or the metabolic syndrome is associated with a higher risk of diabetes and coronary artery disease (CAD). Endothelial dysfunction is a common causal pathway in the initiation and progression of CAD. Methods : A total of 418 patients (165 obese; 239 MetS) with and without angiographic evidence of CAD underwent coronary vascular function testing by measuring coronary blood flow (CBF) velocity in response to intracoronary infusion of acetylcholine (ACH) and sodium nitroprusside (SNP) and coronary flow reserve with adenosine. Results : Endothelium-dependent microvascular vasodilation correlated with body mass index (BMI) (r = -0.12; p = 0.02); with ACH responses significantly lower in overweight; obese and MetS subjects (p = 0.003). The number of MetS components correlated with the response to ACH in both the coronary microcirculation and the epicardial coronary arteries; and with impaired coronary microcirculatory responses to adenosine. No significant correlation was observed with SNP. In multivariable analysis; beyond age; only the total number of MetS components; and not BMI; emerged as an independent predictor of impaired microvascular response to ACH (CBF: ? = -0.18; p 0.001). Low-grade inflammation (C-reactive protein) was higher in patients with MetS; but was not associated with coronary vascular function. Conclusions : We demonstrate that the clustering of MetS components is an important and independent determinant of coronary endothelial dysfunction in subjects with and without CAD

Overview of the Metabolic Syndrome; An Emerging Pandemic of Public Health Significance

A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus; which occur together have become known as the metabolic syndrome. Over the years various diagnostic criteria have been proposed by different organizations and most recently efforts have been made to unify the diagnostic criteria. This article is aimed at providing an overview of the metabolic syndrome and a rational approach to the management of this very important clinical syndrome

Metabolic syndrome using national cholesterol education program criteria in black patients with arterial hypertension

Objective: to assess the prevalence and correlates of the metabolic syndrome (MS) in black patients with essential hypertension. Methods: A total of 100 consecutive essential hypertensives (53 men and 47 women, mean age 49 ± 10 years, BMI 27 ± 5 Kg/m², SBP 155 ± 19 mmHg, DBP 101 ± 11 mmHg) attending the University of Kinshasa outpatient hypertension clinic and included in a case-control study of lipids and lipoproteins were considered for the present cross sectional analysis. All patients underwent clinical, laboratory and electrocardiographic investigations searching for lipid and lipid cardiovascular risk factors. NCEP-ATP III criteria were used to define the MS. Between group comparisons were made with the Student t test, Mann Whitney U test or Chi square as appropriate. Results: 31 hypertensive patients (33%), 23 men and 8 women, fulfilled the NCEP-ATP III criteria of the MS. In univariate analysis, aside the variables defining the MS, patients with the MS had a significantly higher TC/HDL-c ratio (4.44 ± 2.40 vs 3.79 ± 1.82; p ≤ 0.05) and proportion (13% vs 3%, p ≤ 0.05) of smokers; they paradoxically showed lower proportion (39% vs 52%, p ≤ 0.05) of left ventricular hypertrophy (LVH) in comparison to those without the MS. The two groups were similar for age, sex distribution, duration of hypertension, physical activity, treatment status, BP and other biological variables. Multivariate logistic regression analysis was used to determine the independent contribution of risk factors to the risk of MS. Conclusion: MS is common among Congolese patients with essential hypertension and seems to be paradoxically associated with less pronounced cardiac damage probably due to the phenomenon of reverse epidemiology of traditional cardiovascular risk factors

Relative Risk of Metabolic Syndrome Components in Nigerians: the Adult Treatment Panel III Definition

Background: The prevalence of metabolic syndrome is increasing in all populations worldwide and is associated with a substantially elevated risk of type 2 diabetes (5-fold) and of cardiovascular disease (2-3 fold). Metabolic syndrome is now established as a simple means of identifying individuals at increased risk of future cardio vascular disease and type 2 diabetes mellitus. Aim: To determine the prevalence of metabolic syndrome among adult Nigerians attending Family Medicine Clinics at two health facilities in Rivers State; Nigeria and to determine how much each diagnostic criterion contributed to the diagnosis of metabolic syndrome. Methods: Subjects were bled after an overnight fast; and venous blood obtained for lipid studies and fasting blood glucose estimation. Measurements were made to determine height; weight; waist circumference and blood pressure. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Project: Adult Treatment Panel III (ATP III) definition. Results: The unadjusted and age-adjusted prevalence rates of metabolic syndrome at one centre were 19.8and 20.9respectively while they were 34.2and 31.6respectively at the other centre. The prevalence of low HDL-cholesterol was very high at both centres (78.3at one centre and 92.1at the other). Metabolic syndrome is most prevalent in females and older subjects. Conclusion: The prevalence of metabolic syndrome (19.8and 20.9; unadjusted and age-adjusted; respectively) were lower at one centre than the other (34.2and 31.6; unadjusted and age-adjusted; respectively). Despite the very high prevalence of low HDL- cholesterol; the relative risk for metabolic syndrome was not statistical significant (RR=6.73; 95CI: 0.99-45.55)