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      Prevalence of the metabolic syndrome in jamaican adults and its relationship to income and education levels Translated title: Prevalencia del síndrome metabólico en los adultos jamaicanos y relación del síndrome con los ingresos y el nivel de educación

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          Abstract

          OBJECTIVE: To estimate the prevalence of the metabolic syndrome in Jamaican adults and to evaluate its association with socio-economic status (SES). METHODS: A cross-sectional analysis was performed using data from a cohort study of persons, 25-74 years old, living in St Catherine, Jamaica, and who were evaluated between 1993 and 2001. Participants completed an interviewer administered questionnaire and had blood pressure and anthropometric measurements performed by trained observers. Venous blood was collected for measurement of fasting glucose and lipids. The metabolic syndrome was defined using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) criteria. Income and education were used as markers of SES. RESULTS: Data from 1870 participants (717 males 1153 females) were analysed. Prevalence of the metabolic syndrome was 21.1% (95% CI 19.2, 22.9%) using IDF criteria and 18.4% (95% CI 16.6, 20.2%) using the AHA/NHLBI criteria. Prevalence was higher among females (27.6% [IDF], 23.0% [AHA]) compared to males (10.6% [IDF], 11.0% [AHA]). The prevalence of the metabolic syndrome increased with age. Compared to males with primary/lower education, those with secondary and tertiary education had higher odds of having the metabolic syndrome after adjusting for age; odds ratio 3.12 (1.54, 6.34) and 2.61 (1.33, 5.11) respectively. High income was also associated with increased odds of having the metabolic syndrome among males, OR = 6.0 (2.22, 16.19) adjusting for age-group. There were no significant associations among women. CONCLUSION: The metabolic syndrome is common in Jamaica. Clinicians should look for this syndrome in their patients and take steps to treat the abnormalities identified.

          Translated abstract

          OBJETIVO: Estimar la prevalencia del síndrome metabólico en los adultos jamaicanos, y evaluar su asociación con el nivel socioeconómico (NSE). MÉTODOS: Se realizó un análisis transversal usando datos de un estudio de cohorte de personas de 25-74 años de edad en Saint Catherine, Jamaica, evaluadas entre 1993 y 2001. Los participantes respondieron una encuesta administrada por el entrevistador. Asimismo, les fueron hechas mediciones antropométricas y mediciones de la presión arteria, por observadores entrenados. Se tomaron muestras de sangre venosa para medir la glucosa en ayunas y los lípidos. El síndrome metabólico fue definido usando criterios de la Federación Internacional de Diabetes (FID) y la Asociación Americana del Corazón y el Instituto Nacional del Corazón, los Pulmones y la Sangre (AHA/NHLBI, en inglés). Los ingresos y la educación se usaron como marcadores del NSE. RESULTADOS: Se analizaron los datos de 1870 participantes (717 varones y 1153 hembras). La prevalencia del síndrome metabólico fue 21.1% (95% CI 19.2, 22.9%) usando criterios de la FID y 18.4% (95% CI 16.6, 20.2%) usando los criterios de AHA/NHLBI. La prevalencia fue mayor entre las hembras (27.6% [FID], 23.0% [AHA]) en comparación con los varones (10.6% [FID], 11.0% [AHA]). La prevalencia del síndrome metabólico aumentó con la edad. En comparación con los varones con educación primaria/inferior, aquéllos con educación secundaria y terciaria tenían mayor probabilidad de presentar el síndrome metabólico después del ajuste por edad; el cociente de probabilidades (odds ratio) fue 3.12 (1.54, 6.34) y 2.61 (1.33, 5.11) respectivamente. El ingreso alto estuvo también asociado con mayores probabilidades de síndrome metabólico entre los varones, OR = 6.0 (2.22, 16.19) con ajuste por grupo etario. No hubo asociaciones significativas entre las mujeres. CONCLUSIÓN: El síndrome metabólico es común en Jamaica. Los clínicos deben buscar este síndrome en sus pacientes y dar pasos a fin de tratar las anormalidades identificadas.

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          Banting lecture 1988. Role of insulin resistance in human disease.

          G M Reaven (1988)
          Resistance to insulin-stimulated glucose uptake is present in the majority of patients with impaired glucose tolerance (IGT) or non-insulin-dependent diabetes mellitus (NIDDM) and in approximately 25% of nonobese individuals with normal oral glucose tolerance. In these conditions, deterioration of glucose tolerance can only be prevented if the beta-cell is able to increase its insulin secretory response and maintain a state of chronic hyperinsulinemia. When this goal cannot be achieved, gross decompensation of glucose homeostasis occurs. The relationship between insulin resistance, plasma insulin level, and glucose intolerance is mediated to a significant degree by changes in ambient plasma free-fatty acid (FFA) concentration. Patients with NIDDM are also resistant to insulin suppression of plasma FFA concentration, but plasma FFA concentrations can be reduced by relatively small increments in insulin concentration. Consequently, elevations of circulating plasma FFA concentration can be prevented if large amounts of insulin can be secreted. If hyperinsulinemia cannot be maintained, plasma FFA concentration will not be suppressed normally, and the resulting increase in plasma FFA concentration will lead to increased hepatic glucose production. Because these events take place in individuals who are quite resistant to insulin-stimulated glucose uptake, it is apparent that even small increases in hepatic glucose production are likely to lead to significant fasting hyperglycemia under these conditions. Although hyperinsulinemia may prevent frank decompensation of glucose homeostasis in insulin-resistant individuals, this compensatory response of the endocrine pancreas is not without its price. Patients with hypertension, treated or untreated, are insulin resistant, hyperglycemic, and hyperinsulinemic. In addition, a direct relationship between plasma insulin concentration and blood pressure has been noted. Hypertension can also be produced in normal rats when they are fed a fructose-enriched diet, an intervention that also leads to the development of insulin resistance and hyperinsulinemia. The development of hypertension in normal rats by an experimental manipulation known to induce insulin resistance and hyperinsulinemia provides further support for the view that the relationship between the three variables may be a causal one.(ABSTRACT TRUNCATED AT 400 WORDS)
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            The metabolic syndrome

            The metabolic syndrome is a common metabolic disorder that results from the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) will be applicable worldwide. The pathophysiology seems to be largely attributable to insulin resistance with excessive flux of fatty acids implicated. A proinflammatory state probably contributes to the syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. The fundamental approach is weight reduction and increased physical activity; however, drug treatment could be appropriate for diabetes and cardiovascular disease risk reduction.
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              Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.

              The purpose of this research was to assess the association between the metabolic syndrome (MetSyn) and cardiovascular events and mortality by meta-analyses of longitudinal studies. Controversy exists regarding the cardiovascular risk associated with MetSyn. We searched electronic reference databases through March 2005, studies that referenced Reaven's seminal article, abstracts presented at meetings in 2003 to 2004, and queried experts. Two reviewers independently assessed eligibility. Longitudinal studies reporting associations between MetSyn and cardiovascular events or mortality were eligible. Two reviewers independently used a standardized form to collect data from published reports. Authors were contacted. Study quality was assessed by the control of selection, detection, and attrition biases. We found 37 eligible studies that included 43 cohorts (inception 1971 to 1997) and 172,573 individuals. Random effects meta-analyses showed MetSyn had a relative risk (RR) of cardiovascular events and death of 1.78 (95% confidence interval [CI] 1.58 to 2.00). The association was stronger in women (RR 2.63 vs. 1.98, p = 0.09), in studies enrolling lower risk (<10%) individuals (RR 1.96 vs. 1.43, p = 0.04), and in studies using factor analysis or the World Health Organization definition (RR 2.68 and 2.06 vs. 1.67 for National Cholesterol Education Program definition and 1.35 for other definitions; p = 0.005). The association remained after adjusting for traditional cardiovascular risk factors (RR 1.54, 95% CI 1.32 to 1.79). The best available evidence suggests that people with MetSyn are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                wimj
                West Indian Medical Journal
                West Indian med. j.
                The University of the West Indies (Mona, , Jamaica )
                0043-3144
                2309-5830
                June 2010
                : 59
                : 3
                : 265-273
                Affiliations
                [01] Kingston orgnameThe University of the West Indies orgdiv1Tropical Medicine Research Institute Jamaica
                [02] Chicago IL orgnameLoyola University orgdiv1Department of Preventive Medicine and Epidemiology USA
                Article
                S0043-31442010000300008
                7078b3cb-e5d0-43c9-878a-864d4fdcaad8

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                SciELO West Indians

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                Caribbean,Jamaica,metabolic syndrome,socioeconomic status,negros,Caribe,nivel socio-económico,síndrome metabólico,Blacks

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