Original Data

Health Care Access and Prevalence of the Metabolic Syndrome Among Elders Living in High-Altitude Areas of the Mediterranean Islands: The MEDIS Study

Stefanos Tyrovolas¹, Christos Chalkias², Marianthi Morena², Ioanna Tsiligianni³, Akis Zeimbekis⁴, Efthimios Gotsis¹, George Metallinos¹, Vassiliki Bountziouka¹, Evangelos Polychronopoulos¹, Christos Lionis³, Demosthenes Panagiotakos¹

Abstract

AIM: The aim of the present work was to evaluate the relationships between sociodemographic, clinical, and lifestyle characteristics and the presence of metabolic syndrome, among high and low altitude living elderly individuals without known CVD. METHODS: During 2005-2011, 1959 elderly (aged 65 to 100 years) individuals from 13 Mediterranean islands were enrolled. Sociodemographic, clinical, and lifestyle factors were assessed using standard procedures. Metabolic syndrome was defined according to the (Adult Treatment Panel) ATP III criteria. Mountainous areas were defined those more than 400 meters in height. RESULTS: For the present analysis 713 men and 596 women were studied; the prevalence of the metabolic syndrome was 29% (24% in men, 35% in women, p < 0.001). Furthermore, the prevalence of metabolic syndrome was 55% in the elders living in mountainous areas, as compared with 26% among those living at sea-level (p = 0.01). Similarly, the prevalence of hypertension, hypercholesterolemia, and obesity were higher in high altitude as compared with low altitude areas (all p-values < 0.01). After adjusting for various confounders, elders living in high altitude areas were 3.06-times more likely to have the metabolic syndrome than those living at sea-level (OR = 3.06, 95%CI 2.02-4.65). However, when the annual number of visits to health care centers was taken into account, the effect of altitude of living was not associated with the presence of the syndrome. CONCLUSIONS: A considerable proportion of mountainous living elderly had the metabolic syndrome. Public health actions need to be taken to reduce the burden of cardiometabolic disorders by enabling better access to health care, especially in remote mountainous rural areas.

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Acute Effects of Dietary Fat on Inflammatory Markers and Gene Expression in First-Degree Relatives of Type 2 Diabetes Patients

Anna Pietraszek, Søren Gregersen, Kjeld Hermansen

Abstract

BACKGROUND: Subjects with type 2 diabetes (T2D) and their relatives (REL) carry an increased risk of cardiovascular disease (CVD). Low-grade inflammation, an independent risk factor for CVD, is modifiable by diet. Subjects with T2D show elevated postprandial inflammatory responses to fat-rich meals, while information on postprandial inflammation in REL is sparse. AIM: To clarify whether medium-chain saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) have differential acute effects on low-grade inflammation in REL compared to controls (CON). METHODS: In randomized order, 17 REL and 17 CON ingested two fat-rich meals, with 72 energy percent from MUFA and 79 energy percent from mainly medium-chain SFA, respectively. Plasma high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), adiponectin, and leptin were measured at baseline, 15 min, 60 min, and 240 min postprandially. Muscle and adipose tissue biopsies were taken at baseline and 210 min after the test meal, and expression of selected genes was analyzed. RESULTS: Plasma IL-6 increased (p < 0.001) without difference between REL and CON and between the meals, whereas plasma adiponectin and plasma hs-CRP were unchanged during the 240 min observation period. Plasma leptin decreased slightly in response to medium-chain SFA in both groups, and to MUFA in REL. Several genes were differentially regulated in muscle and adipose tissue of REL and CON. CONCLUSIONS: MUFA and medium-chain SFA elicit similar postprandial circulating inflammatory responses in REL and CON. Medium-chain SFA seems more proinflammatory than MUFA, judged by the gene expression in muscle and adipose tissue of REL and CON.

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Normal Fasting Plasma Glucose and Risk of Prediabetes and Type 2 Diabetes: The Isfahan Diabetes Prevention Study

Mohsen Janghorbani^1,2, Masoud Amini²

Abstract

AIM: To determine the association of fasting plasma glucose (FPG) level within normal range and the risk of prediabetes and type 2 diabetes in an Iranian population. METHODS: A total of 806 first-degree relatives (FDRs) of patients with type 2 diabetes who had FPG levels less than 5.6 mmol/l (100 mg/dl) in 2003 to 2005, and who did not have diabetes or impaired fasting glucose (IFG), were followed through 2010 for the occurrence of prediabetes or type 2 diabetes. At baseline and through follow-ups, participants underwent a standard 75 g 2-hour oral glucose tolerance test (OGTT). RESULTS: The incidence of type 2 diabetes, impaired glucose tolerance (IGT), and IFG was 9.6 (95% confidence interval (CI): 6.8-12.4), 28.7 (23.8-33.6), and 33.0 (27.7-38.2) per 1,000 person-years based on 4,489 person-years of follow-up, respectively. FPG was associated with the incidence of diabetes, IGT, and IFG. The multivariate-adjusted hazard ratios (95% CI) for diabetes, IGT, and IFG were 1.36 (1.01-1.84), 1.45 (1.10-1.91) and 1.31 (1.00-1.71), for the highest quintile of FPG compared with the lowest quintile, respectively. CONCLUSIONS: An increase in FPG in the normal range is associated with an increase in the incidence of IGT, IFG, and type 2 diabetes. These results prove FPG in the normal range to be useful in identifying apparently healthy FDRs of patients with type 2 diabetes at risk of developing prediabetes and diabetes.

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