Associations of non-traditional cardiovascular risk factors and body mass index with metabolic syndrome in the Chinese elderly population

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Abstract

Background

Metabolic syndrome (MetS), a clustering of traditional cardiovascular risk factors (CVRF), is currently one of the major global public health burdens. However, associations between MetS and non-traditional CVRF represented by uric acid (UA), homocysteine (HCY) and hypersensitive C-reactive protein (HsCRP) have not been well explored in the elderly population, especially when considering body mass index (BMI).

Methods

Participants from the Shanghai Elderly Cardiovascular Health (SHECH) study cohort in 2017 were analyzed. MetS was defined using the modified American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Logistic regression models were used to assess associations of non-traditional CVRF, BMI with MetS.

Results

Of the 4360 participants analyzed, 2378 (54.5%) had MetS, the mean (SD) UA was 331 (86) µmol/L, and the median (IQR) HCY and HsCRP were 15 (13–18) µmol/L and 1.0 (0.5–2.1) mg/L, respectively. Participants with higher non-traditional CVRF tended to have a higher significant risk of MetS ( P < 0.001), which did not changed substantially in most population subgroups ( P-interaction > 0.05). BMI mediated 43.89% (95%CI: 30.38–57.40%), 37.34% (95% CI: 13.86–60.83%) and 30.99% (95%CI: 13.16–48.83%) of associations of hyperuricemia (HUA), hyperhomocysteinemia (HHCY) and high HsCRP (HHsCRP) with MetS, respectively. Abnormal non-traditional CVRF combined with overweight/obesity greatly increased MetS risk (adjusted OR(95%CI): HUA + Overweight: 5.860(4.059-8.461); 6.148(3.707–10.194); HHCY + Overweight: 3.989(3.107-5.121); HHCY + Obese: 5.746(4.064–8.123); HHsCRP + Overweight: 4.026(2.906-5.580); HHsCRP + Obese: 7.717(4.508–13.210)).

Conclusions

In the Chinese elderly population, HUA, HHCY, and HHsCRP were all significantly and independently associated with MetS, supporting the potential of focusing on non-traditional CVRF interventions for preventing and controlling MetS. BMI played moderate mediating roles in associations between non-traditional CVRF and MetS, and abnormal non-traditional CVRF combined with overweight/obesity had significant synergistic effects on MetS risk, highlighting the importance of better weight management in the elderly population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13098-023-01047-4.

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Most cited references 75

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Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.

Scott M. Grundy, James I Cleeman, Stephen R Daniels … (2005)

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The Global Epidemic of the Metabolic Syndrome

Mohammad G. Saklayen (2018)

Metabolic syndrome, variously known also as syndrome X, insulin resistance, etc., is defined by WHO as a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. Though there is some variation in the definition by other health care organization, the differences are minor. With the successful conquest of communicable infectious diseases in most of the world, this new non-communicable disease (NCD) has become the major health hazard of modern world. Though it started in the Western world, with the spread of the Western lifestyle across the globe, it has become now a truly global problem. The prevalence of the metabolic syndrome is often more in the urban population of some developing countries than in its Western counterparts. The two basic forces spreading this malady are the increase in consumption of high calorie-low fiber fast food and the decrease in physical activity due to mechanized transportations and sedentary form of leisure time activities. The syndrome feeds into the spread of the diseases like type 2 diabetes, coronary diseases, stroke, and other disabilities. The total cost of the malady including the cost of health care and loss of potential economic activity is in trillions. The present trend is not sustainable unless a magic cure is found (unlikely) or concerted global/governmental/societal efforts are made to change the lifestyle that is promoting it. There are certainly some elements in the causation of the metabolic syndrome that cannot be changed but many are amenable for corrections and curtailments. For example, better urban planning to encourage active lifestyle, subsidizing consumption of whole grains and possible taxing high calorie snacks, restricting media advertisement of unhealthy food, etc. Revitalizing old fashion healthier lifestyle, promoting old-fashioned foods using healthy herbs rather than oil and sugar, and educating people about choosing healthy/wholesome food over junks are among the steps that can be considered.

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The complex role of estrogens in inflammation.

Rainer H. Straub (2007)

There is still an unresolved paradox with respect to the immunomodulating role of estrogens. On one side, we recognize inhibition of bone resorption and suppression of inflammation in several animal models of chronic inflammatory diseases. On the other hand, we realize the immunosupportive role of estrogens in trauma/sepsis and the proinflammatory effects in some chronic autoimmune diseases in humans. This review examines possible causes for this paradox. This review delineates how the effects of estrogens are dependent on criteria such as: 1) the immune stimulus (foreign antigens or autoantigens) and subsequent antigen-specific immune responses (e.g., T cell inhibited by estrogens vs. activation of B cell); 2) the cell types involved during different phases of the disease; 3) the target organ with its specific microenvironment; 4) timing of 17beta-estradiol administration in relation to the disease course (and the reproductive status of a woman); 5) the concentration of estrogens; 6) the variability in expression of estrogen receptor alpha and beta depending on the microenvironment and the cell type; and 7) intracellular metabolism of estrogens leading to important biologically active metabolites with quite different anti- and proinflammatory function. Also mentioned are systemic supersystems such as the hypothalamic-pituitary-adrenal axis, the sensory nervous system, and the sympathetic nervous system and how they are influenced by estrogens. This review reinforces the concept that estrogens have antiinflammatory but also proinflammatory roles depending on above-mentioned criteria. It also explains that a uniform concept as to the action of estrogens cannot be found for all inflammatory diseases due to the enormous variable responses of immune and repair systems.

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Author and article information

Contributors

Qian Xue: chyybb@yeah.net

Yuzhen Zhang: Yzzhang-tj@tongji.edu.cn

Liang Zheng: zhengliang@tongji.edu.cn

Journal

Journal ID (nlm-ta): Diabetol Metab Syndr

Journal ID (iso-abbrev): Diabetol Metab Syndr

Title: Diabetology & Metabolic Syndrome

Publisher: BioMed Central (London )

ISSN (Electronic): 1758-5996

Publication date (Electronic): 16 June 2023

Publication date PMC-release: 16 June 2023

Publication date Collection: 2023

Volume: 15

Electronic Location Identifier: 129

Affiliations

[1 ]GRID grid.24516.34, ISNI 0000000123704535, Department of Epidemiology and Public Health, , Tongji University School of Medicine, ; Shanghai, 200092 China

[2 ]GRID grid.24516.34, ISNI 0000000123704535, Research Center for Translational Medicine, Shanghai East Hospital, , Tongji University School of Medicine, ; Shanghai, 200120 China

[3 ]GRID grid.24516.34, ISNI 0000000123704535, Institute of Integrated Traditional Chinese and Western Medicine for Cardiovascular Chronic Diseases, , Tongji University School of Medicine, ; Shanghai, 200120 China

[4 ]GRID grid.73113.37, ISNI 0000 0004 0369 1660, Department of Health Statistics, Faculty of Health Service, , Naval Medical University, ; Shanghai, 200433 China

[5 ]GRID grid.73113.37, ISNI 0000 0004 0369 1660, Changhai Clinical Research Unit, , Shanghai Changhai Hospital, Naval Medical University, ; Shanghai, 200433 China

Article

Publisher ID: 1047

DOI: 10.1186/s13098-023-01047-4

PMC ID: 10273701

PubMed ID: 37322514

SO-VID: 11095817-c3ee-4c2e-a6df-d607acd4b6a3

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 February 2023

Date accepted : 29 March 2023

Funding

Funded by: the Science and Technology Plan Project of Jiangxi Provincial Health Commission

Award ID: SKJP220227143

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: cardiovascular disease,non-traditional cardiovascular risk factors,metabolic syndrome,body mass index,the elderly population

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: cardiovascular disease, non-traditional cardiovascular risk factors, metabolic syndrome, body mass index, the elderly population

Associations of non-traditional cardiovascular risk factors and body mass index with metabolic syndrome in the Chinese elderly population

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Abstract

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Supplementary Information

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Most cited references 75

Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.

The Global Epidemic of the Metabolic Syndrome

The complex role of estrogens in inflammation.

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