Remission of screen-detected metabolic syndrome and its determinants: an observational study

BMC Public Health

Guy E Rutten¹  Maureen van den Donk¹  Philippe L Salomé²  Kees J Gorter¹  Corine den Engelsen¹ 

[1] Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnr STR.6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands;Huisartsenzorg IJsselstein, locatie 't Steyn, Eiteren 15, 3401 PS, IJsselstein, Netherlands

关键词: Primary care;    Cardiovascular risk;    Screening;    Abdominal obesity;    Metabolic syndrome;   

Others  :  1163102
DOI  :  10.1186/1471-2458-12-778

 received in 2012-01-30, accepted in 2012-09-10,  发布年份 2012

【 摘 要 】

Background

Early detection and treatment of the metabolic syndrome may prevent diabetes and cardiovascular disease. Our aim was to assess remission of the metabolic syndrome and its determinants after a population based screening without predefined intervention in the Netherlands.

Methods

In 2006 we detected 406 metabolic syndrome cases (The National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP III) definition) among apparently healthy individuals with an increased waist circumference. They received usual care in a primary care setting. After three years metabolic syndrome status was re-measured. We evaluated which baseline determinants were independently associated with remission.

Results

The remission rate among the 194 participants was 53%. Baseline determinants independently associated with a remission were the presence of more than three metabolic syndrome components (OR 0.46) and higher levels of waist circumference (OR 0.91), blood pressure (OR 0.98) and fasting glucose (OR 0.60).

Conclusions

In a population with screen-detected metabolic syndrome receiving usual care, more than half of the participants achieved a remission after three years. This positive result after a relatively simple strategy provides a solid basis for a nation-wide implementation. Not so much socio-demographic variables but a higher number and level of the metabolic syndrome components were predictors of a lower chance of remission. In such cases, primary care physicians should be extra alert.

【 授权许可】

   
2012 den Engelsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Ford ES, Schulze MB, Pischon T, Bergmann MM, Joost HG, Boeing H: Metabolic syndrome and risk of incident diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study. Cardiovasc Diabetol 2008, 7:35. BioMed Central Full Text
• [2]Galassi A, Reynolds K, He J: Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med 2006, 119:812-819.
• [3]Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, Montori VM: Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 2007, 49:403-414.
• [4]Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM: The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care 2003, 26:3153-3159.
• [5]Hansson L, Lindholm LH, Niskanen L, Lanke J, Hedner T, Niklason A, Luomanmaki K, Dahlof B, Morlin C, Karlberg BE, Wester PO, Bjorck JE, De FU: JE: Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999, 353:611-616.
• [6]Hansson L, Hedner T, Lund-Johansen P, Kjeldsen SE, Lindholm LH, Syvertsen JO, Lanke J, De FU, Dahlof B, Karlberg BE: Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000, 356:359-365.
• [7]UK Prospective Diabetes Study (UKPDS) Group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998, 352:854-865.
• [8]Wong ND, Pio JR, Franklin SS, L'Italien GJ, Kamath TV, Williams GR: Preventing coronary events by optimal control of blood pressure and lipids in patients with the metabolic syndrome. Am J Cardiol 2003, 91:1421-1426.
• [9]Bagshaw SM, Bellomo R: The need to reform our assessment of evidence from clinical trials: a commentary. Philos Ethics Humanit Med 2008, 3:23. BioMed Central Full Text
• [10]Van den Donk M, Bobbink IWG, Gorter KJ, Salomé PL, Rutten GEHM: Identifying people with metabolic syndrome in primary care by screening with a mailed tape measure. A survey in 14,000 people in the Netherlands. Prev Med 2009, 48:345-350.
• [11]Stalman WA, Scheltens T, Burgers JS, Hukkelhoven CW, Smorenburg SM, Banga JD, Dippel DW: NHG-Standaard Cardiovasculair risicomanagement. Houten: Bohn Stafleu van Loghum; 2006.
• [12]Rutten GEHM, De Grauw WJC, Nijpels G, Goudswaard AN, Uitewaal PJM, Van der Does FEE, Heine RJ, Van Ballegooie E, Verduijn MM, Bouma M: NHG-Standaard Diabetes mellitus type 2 (Tweede herziening). Huisarts en Wetenschap 2006, 49:137-52.
• [13]Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D: Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 2003, 56:1163-1169.
• [14]Kemper HGC, Ooijendijk WTM, Stiggelbout M: Consensus over de Nederlandse Norm voor Gezond Bewegen. Tijdschrift voor Sociale Gezondheidszorg 2000, 78:180-183.
• [15]Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr: Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009, 120:1640-1645.
• [16]Lerman RH, Minich DM, Darland G, Lamb JJ, Schiltz B, Babish JG, Bland JS, Tripp ML: Enhancement of a modified Mediterranean-style, low glycemic load diet with specific phytochemicals improves cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia in a randomized trial. Nutr Metab (Lond) 2008, 5:29. BioMed Central Full Text
• [17]Lundgren JD, Malcolm R, Binks M, O'Neil PM: Remission of metabolic syndrome following a 15-week low-calorie lifestyle change program for weight loss. Int J Obes (Lond) 2009, 33:144-150.
• [18]Salas-Salvado J, Fernandez-Ballart J, Ros E, Martinez-Gonzalez MA, Fito M, Estruch R, Corella D, Fiol M, Gomez-Gracia E, Aros F, Flores G, Lapetra J, Lamuela-Raventos R, Ruiz-Gutierrez V, Bullo M, Basora J, Covas MI: Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med 2008, 168:2449-2458.
• [19]Hightower KR, Olson RE, Gellish RL, Russi GD, Goslin BR, Moudgil VK: Reversal of metabolic syndrome characteristics. Metab Syndr Relat Disord 2007, 5:69-76.
• [20]Maxwell MS, Goslin BR, Gellish RL, Hightower KR, Olson RE, Moudgil VK, Russi GD: Metabolic syndrome status changes with fitness level change: a retrospective analysis. Metab Syndr Relat Disord 2008, 6:8-14.
• [21]Anderssen SA, Carroll S, Urdal P, Holme I: Combined diet and exercise intervention reverses the metabolic syndrome in middle-aged males: results from the Oslo Diet and Exercise Study. Scand J Med Sci Sports 2007, 17:687-695.
• [22]Lee WJ, Huang MT, Wang W, Lin CM, Chen TC, Lai IR: Effects of obesity surgery on the metabolic syndrome. Arch Surg 2004, 139:1088-1092.
• [23]Nugent C, Bai C, Elariny H, Gopalakrishnan P, Quigley C, Garone M Jr, Afendy M, Chan O, Wheeler A, Afendy A, Younossi ZM: Metabolic syndrome after laparoscopic bariatric surgery. Obes Surg 2008, 18:1278-1286.
• [24]Rossi M, da SR BF, Chaves AG Jr, Regina PF, Martin Bianco RF, Serpa NA, Zimberg CE: Remission of metabolic syndrome: a study of 140 patients six months after Roux-en-Y gastric bypass. Obes Surg 2008, 18:601-606.
• [25]Filippatos TD, Kiortsis DN, Liberopoulos EN, Georgoula M, Mikhailidis DP, Elisaf MS: Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin 2005, 21:1997-2006.
• [26]Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S: The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 2005, 142:611-619.
• [27]Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, Lucia C, Nuti C, Durazzo M, Cassader M, Gentile L, Pagano G: Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. J Gen Intern Med 2007, 22:1695-1703.
• [28]Bihan H, Takbou K, Cohen R, Michault A, Boitou F, Reach G, Le CH: Impact of short-duration lifestyle intervention in collaboration with general practitioners in patients with the metabolic syndrome. Diabetes Metab 2009, 35:185-191.
• [29]Onat A, Hergenc G: Low-grade inflammation, and dysfunction of high-density lipoprotein and its apolipoproteins as a major driver of cardiometabolic risk. Metabolism 2011, 60:499-512.
• [30]Onat A: Metabolic syndrome: nature, therapeutic solutions and options. Expert Opin Pharmacother 2011, 12:1887-1900.
• [31]Burke TA, Sturkenboom MC, Lu SE, Wentworth CE, Lin Y, Rhoads GG: Discontinuation of antihypertensive drugs among newly diagnosed hypertensive patients in UK general practice. J Hypertens 2006, 24:1193-1200.
• [32]Tsuyuki RT, Bungard TJ: Poor adherence with hypolipidemic drugs: a lost opportunity. Pharmacotherapy 2001, 21:576-582.
• [33]Van Wijk BL, Klungel OH, Heerdink ER, De BA: Rate and determinants of 10-year persistence with antihypertensive drugs. J Hypertens 2005, 23:2101-2107.