Exercise Blood Pressure Response and Cardiometabolic Risk Factors in Middle Aged Women: A MONET Group Study

Objective: To investigate if an exaggerated peak exercise systolic blood pressure (peak ESBP) is associated with alteration of cardiometabolic risk factors and predict future resting hypertension in middle aged women. Methods: Data analysis was performed in 95 healthy normotensive premeno-pausal women at baseline and 84 after 5-year follow-up (age, 49.9 ± 1.9 years;BMI, 23.3 ± 2.2 kg/m2;resting BP, 117/73 ± 11.8/7.6 mmHg). Blood pressure was measured at rest and during a progressive exercise test on treadmill. Women were divided into two groups according to their peak ESBP <190 mmHg vs. ≥190 mmHg. Other outcome measures were: cardiorespiratory fitness (VO2 peak), body composition, body fat distribution and fasting plasma lipids, glucose and insulin levels. Results: 15% and 27% of women presented an exaggerated peak ESBP response (≥190 mmHg) at baseline and year 5 respectively. Linear mixed model repeated measures analysis revealed higher values of fasting glucose, resting systolic and diastolic BP in women with an exaggerated peak ESBP (≥190 mmHg) compared to women with a peak ESBP (<190 mmHg). No significant difference was observed between the two groups for VO2 peak, body composition and body fat distribution indices and other cardiometabolic risk factors. Finally, baseline peak ESBP was not a significant risk factor for future resting hypertension (OR: 2.96, 95%CI [0.48 - 18.12];P = 0.24). Conclusion: Our results, despite being non significant, are of great interest because in healthy and active premenopausal women, exaggerated peak ESBP is not predictive of future hypertension after 5-year follow-up throughout menopause transition.

Percent body fat,but not body mass index,is associated with cardiometabolic risk factors in children and adolescents

Background:The epidemic of overweight and obesity has become a worldwide public health problem.Cardiometabolic diseases may originate in childhood.We investigated the association between percent body fat(PBF)measured by the bioelectrical impedance assay and cardiometabolic risk(CMR)in pediatrics.Methods:This cross-sectional study involved 3819 subjects(6-17 years old)in Shanghai.We assessed the association between PBF and body mass index(BMI)with multiple CMR factors.We examined the risk for cardiometabolic abnormalities attributable to overweight and obesity based on age-and sexspecific PBF Z-scores and BMI Z-scores,respectively.Results:PBF,but not BMI,was positively associated with multiple CMR factors in males and females except for total cholesterol in females(all p<0.05).Compared with the non-overweight group based on PBF,overweight and obese subjects had increasingly higher odds ratio of dyslipidemia(2.90(1.99-4.23),4.59(2.88-7.32)for males and 1.82(1.20-2.75),2.46(1.47-4.11)for females)and elevated blood pressure(BP)(3.26(2.35-4.51),4.55(2.92-7.09)for males and 1.59(1.07-2.34),3.98(2.27-6.17)for females).Obesity females showed a higher likelihood for hyperglycemia(2.19(1.24-3.84))than non-overweight females.In both sexes,the predictive effect of PBF on dyslipidemia and elevated BP in adolescents was better than that in children.For hyperglycemia,the predictive effect of PBF was better in male adolescents and female children.There was no risk difference for cardiometabolic abnormalities attributable to BMI-based obesity categories.Conclusions:PBF but not BMI was associated with CMR.Overweight and obesity categories based on PBF had an increased risk for cardiometabolic abnormalities in children and adolescents.

Association between physical activity energy expenditure and cardiometabolic risk factor clustering among Chinese adults in 2015

To understand the association between cardiometabolic risk factor(CMRF)clustering and physical activity(PA)levels,we included 86520 Chinese adults aged 18–64 years having at least one CMRF(hypertension,diabetes,dyslipidemia,or obesity)from the China Chronic Disease and Nutrition Surveillance survey in 2015,a nationally and provincially representative investigation with a multistage clustering sampling design.Self-reported PA information was collected with the Global Physical Activity Questionnaire through face-to-face interviews.In view of the obesity epidemic in CMRF patients,PA energy expenditure(PAEE)per kilogram body weight was used,and was defined into four categories:(i)inactivity:0 kJ/kg/day;(ii)low activity:0–5 kJ/kg/day;(iii)moderate activity:6–11 kJ/kg/day;and(iv)vigorous activity:≥12 kJ/kg/day.The estimated weighted prevalence(95%confidence interval[CI])of having 1,2,3,and 4 CMRFs was 60.57%(59.48%–61.67%),28.10%(27.40%–28.79%),9.82%(9.22%–15.42%)and 1.50%(1.37%–1.63%),respectively.The rate(95%CI)of inactivity,low activity,moderate activity,and vigorous activity was 34.52%(32.69%–36.35%),22.22%(21.37%–23.37%),15.98%(15.38%–16.58%)and 27.28%(26.02%–28.53%),respectively.For those having 2,3 and 4 CMRFs(compared to those having 1 CMRF),the adjusted odds ratio(95%CI)for moderate activity and vigorous activity were 0.91(0.85–0.98)and 0.92(0.85–0.99),0.87(0.80–0.95)and 0.84(0.77–0.92),and 0.77(0.67–0.89)and 0.85(0.72–1.00),respectively.In conclusion,CMRF clustering was a pandemic among Chinese adults in 2015 and was inversely associated with PA level.PAEE(in kJ/kg/day)may be introduced into PA management practice,especially for populations with high body weight.

Obstructive Sleep Apnea Syndrome is Associated with Metabolic Syndrome among Adolescents and Youth in Beijing： Data from Beijing Child and Adolescent Metabolic Syndrome Study

Background： Obstructive sleep apnea （OSA） syndrome has a negative impact on the health of millions of adolescents and youth. The aim of this study was to evaluate the associations of OSA syndrome with obesity and cardiometabolic risk factors among adolescents and youth at risk for metabolic syndrome （MS）.Methods： A total of 558 subjects aged 14-28 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome Study. Each underwent a 2-h oral glucose tolerance test （OGTT）, echocardiography, and liver ultrasonography. Anthropometric measures, blood levels of glucose, lipids, and liver enzymes were assessed. Subjects with high or low risk for OSA were identified by Berlin Questionnaire （BQ）. Results： Among the subjects in obesity, 33.7% of whom were likely to have OSAby BQ. Subjects with high risk for OSA had higher neck and waist circumference and fat mass percentage compared to those with low risk for OSA （P 〈 0.001 ）. Moreover, significant differences in levels of lipids, glucose after OGTT, and liver enzymes, as well as echocardiographic parameters were found between the two groups with high or low risk for OSA （P 〈 0.05）. The rates of nonalcoholic fatty liver disease （71.0% vs. 24.2%）, MS （38.9% vs. 7.0%）, and its components in high-risk group were significantly higher than in low-risk group. Conclusions： The prevalence of OSA by BQ was high in obese adolescents and youth. A high risk for OSA indicates a high cardiometabolic risk. Mechanisms mediating the observed associations require further investigation.

Metabolic-associated Fatty Liver Disease(MAFLD):A Multi-systemic Disease Beyond the Liver

Nonalcoholic fatty liver disease(NAFLD)is a multisystemic clinical condition that presents with a wide spectrum of extrahepatic manifestations,such as obesity,type 2 diabetes mellitus,metabolic syndrome,cardiovascular diseases,chronic kidney disease,extrahepatic malignancies,cogni-tive disorders,and polycystic ovarian syndrome.Among NAFLD patients,the most common mortality etiology is cardiovascular disorders,followed by extrahepatic malignancies,diabetes mellitus,and liver-related complications.Furthermore,the severity of extrahepatic diseases is parallel to the severity of NAFLD.In clinical practice,awareness of the associations of concomitant diseases is of major importance for initiating prompt and timely screening and multidisciplinary management of the disease spectrum.In 2020,a consensus from 22 countries redefined the disease as metabolic(dysfunction)-associated fatty liver disease(MAFLD),which resulted in the redefinition of the corre-sponding population.Although the patients diagnosed with MAFLD and NAFLD mostly overlap,the MAFLD and NAFLD populations are not identical.In this review,we compared the associations of key extrahepatic diseases between NAFLD and MAFLD.

Metabolic hypertension:concept and practice

Hypertension is a serious public health problem worldwide.More than 60%of the risk factors for hypertension are associated with metabolic disturbances.Metabolic abnormalities increase the risk for hypertension and cause high blood pressure.Improving metabolic disturbances is beneficial for hypertension treatment.Due to the importance of metabolic abnormalities in the pathogenesis of hypertension,we propose a concept of metabolic hypertension.In this review,we discuss and review the clinical types,pathogenesis,risk evaluation and management of metabolic hypertension.Elucidation of the mechanism of metabolic hypertension should facilitate the design of novel pharmacotherapeutics and dedicated antihypertensive manipulations.