Martin Laclaustra

Prevalencia del síndrome metabólico en población laboral española: registro MESYAS

Introduccion y objetivos Estudiar la prevalencia del sindrome metabolico (SM) en la poblacion laboral activa espanola y analizar sus diferencias segun las categorias laborales. Sujetos y metodo Se recogieron los datos de 7.256 trabajadores activos (un 82,4% varones), con una edad media de 45,4 ± 9,8 anos, empleados en una factoria de coches y unos grandes almacenes. El diagnostico del SM se realizo mediante los criterios modificados del ATP-III (se utilizo el indice de masa corporal en lugar del perimetro abdominal). Resultados La prevalencia bruta del SM fue del 10,2%. Ajustada por edad y sexo en una poblacion plana (20-60 anos) fue del 5,8% (intervalo de confianza [IC] del 95%, 4,1-7,6%), significativamente mas alta en varones que en mujeres (el 8,7%; IC del 95%, 7,3-10,0 frente al 3,0%; IC del 95%, 0,8-5,1). Todos los componentes del SM fueron significativamente mas prevalentes en varones, excepto las concentraciones de lipoproteinas de alta densidad, que fueron mas bajas. La prevalencia aumento con la edad y el sexo masculino (odds ratio [OR] = 1,7), la obesidad (OR = 9,6), la hipertension (OR = 3,4) y la diabetes (OR = 15,4). Los trabajadores manuales presentaron la mayor prevalencia de SM (11,8%), seguidos por los trabajadores de oficina (9,3%) y los directivos (7,7%) (gradiente social inverso). Los trabajadores manuales tienen un riesgo superior de presentar SM, con independencia de la edad y el sexo (OR = 1,3); este efecto parece depender de las concentraciones de trigliceridos. Conclusiones Uno de cada 10 trabajadores activos tiene SM; la prevalencia aumenta con la edad y el sexo masculino. La obesidad y la diabetes suponen gran incremento de la prevalencia. Los trabajadores manuales son el colectivo con mayor prevalencia.

Serum selenium and serum lipids in US adults: National Health and Nutrition Examination Survey (NHANES) 2003–2004

OBJECTIVE High selenium has been recently associated with several cardiovascular and metabolic risk factors including diabetes, blood pressure and lipid levels. We evaluated the association of serum selenium with fasting serum lipid levels in the National Health and Nutrition Examination Survey (NHANES) 2003-2004, the most recently available representative sample of the US population that measured selenium levels. METHODS Cross-sectional analysis of 1159 adults>or=40 years old from NHANES 2003-2004. Serum selenium was measured by inductively coupled plasma-dynamic reaction cell-mass spectrometry. Fasting serum total cholesterol, triglycerides, and HDL cholesterol were measured enzymatically and LDL cholesterol was calculated. RESULTS Mean serum selenium was 136.7 microg/L. The multivariable adjusted average differences (95% confidence interval) comparing the highest (>or=147 microg/L) to the lowest (<124 microg/L) selenium quartiles were 18.9 (9.9, 28.0) mg/dL for total cholesterol, 12.7 (3.3, 22.2) mg/dL for LDL cholesterol, 3.9 (0.4, 7.5)mg/dL for HDL cholesterol, and 11.5 (-7.6, 30.7) mg/dL for triglycerides. In spline regression models, total and LDL cholesterol levels increased progressively with increasing selenium concentrations. HDL cholesterol increased with selenium but reached a plateau above 120 microg/L of serum selenium (20th percentile). The triglyceride-selenium relationship was U-shaped. CONCLUSION In US adults, high serum selenium concentrations were associated with increased serum concentrations of total and LDL cholesterol. Selenium was associated with increasing HDL cholesterol only at low selenium levels. Given increasing trends in dietary selenium intake and supplementation, the causal mechanisms underlying these associations need to be fully characterized.

Higher Selenium Status is Associated with Adverse Blood Lipid Profile in British Adults

Recent findings have raised concern about possible associations of high selenium exposure with diabetes and hyperlipidemia in the US, a population with high selenium status. In the UK, a population with lower selenium status, there is little data on the association of selenium status with cardio-metabolic risk factors in the general population. We examined the association of plasma selenium concentration with blood lipids in a nationally representative sample of British adults. A cross-sectional study was conducted among 1042 white participants (aged 19-64 y) in the 2000-2001 UK National Diet and Nutrition Survey. Plasma selenium was measured by inductively coupled-plasma mass spectrometry. Total and HDL cholesterol were measured in nonfasting plasma samples. Mean plasma selenium concentration was 1.10 +/- 0.19 micromol/L. The multivariate adjusted differences between the highest (> or =1.20 micromol/L) and lowest (<0.98 micromol/L) quartiles of plasma selenium were 0.39 (95% CI 0.18, 0.60) mmol/L for total cholesterol, 0.38 (0.17, 0.59) for non-HDL cholesterol, and 0.01 (-0.05, 0.07) for HDL cholesterol. Higher plasma selenium (i.e., > or =1.20 micromol/L) was associated with increased total and non-HDL cholesterol levels but not with HDL in the UK adult population. These findings raise additional concern about potential adverse cardio-metabolic effects of high selenium status. Randomized and mechanistic evidence is necessary to assess causality and to evaluate the impact of this association on cardiovascular risk.

Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort The PESA (Progression of Early Subclinical Atherosclerosis) Study

Background— Data are limited on the presence, distribution, and extent of subclinical atherosclerosis in middle-aged populations. Methods and Results— The PESA (Progression of Early Subclinical Atherosclerosis) study prospectively enrolled 4184 asymptomatic participants 40 to 54 years of age (mean age, 45.8 years; 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic, and iliofemoral territories by 2-/3-dimensional ultrasound and coronary artery calcification by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque or coronary artery calcification ≥1, was classified as focal (1 site affected), intermediate (2–3 sites), or generalized (4–6 sites) after exploration of each vascular site (right/left carotids, aorta, right/left iliofemorals, and coronary arteries). Subclinical atherosclerosis was present in 63% of participants (71% of men, 48% of women). Intermediate and generalized atherosclerosis was identified in 41%. Plaques were most common in the iliofemorals (44%), followed by the carotids (31%) and aorta (25%), whereas coronary artery calcification was present in 18%. Among participants with low Framingham Heart Study (FHS) 10-year risk, subclinical disease was detected in 58%, with intermediate or generalized disease in 36%. When longer-term risk was assessed (30-year FHS), 83% of participants at high risk had atherosclerosis, with 66% classified as intermediate or generalized. Conclusions— Subclinical atherosclerosis was highly prevalent in this middle-aged cohort, with nearly half of the participants classified as having intermediate or generalized disease. Most participants at high FHS risk had subclinical disease; however, extensive atherosclerosis was also present in a substantial number of low-risk individuals, suggesting added value of imaging for diagnosis and prevention. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01410318.

A prospective study of dietary selenium intake and risk of type 2 diabetes

BackgroundGrowing evidence raises concern about possible associations of high selenium exposure with diabetes in selenium-replete populations such as the US. In countries with lower selenium status, such as Italy, there is little epidemiological evidence on the association between selenium and diabetes. This study examined the prospective association between dietary selenium intake and risk of type 2 diabetes.MethodsThe ORDET cohort study comprised a large sample of women from Northern Italy (n = 7,182). Incident type 2 diabetes was defined as a self-report of a physician diagnosis, use of antidiabetic medication, or a hospitalization discharge. Dietary selenium intake was measured by a semi-quantitative food-frequency questionnaire at the baseline examination (1987-1992). Participants were divided in quintiles based on their baseline dietary selenium intake.ResultsAverage selenium intake at baseline was 55.7 μg/day. After a median follow-up of 16 years, 253 women developed diabetes. In multivariate logistic regression analyses, the odds ratio for diabetes comparing the highest to the lowest quintile of selenium intake was 2.39, (95% CI: 1.32, 4.32; P for linear trend = 0.005). The odds ratio for diabetes associated with a 10 μg/d increase in selenium intake was 1.29 (95% CI: 1.10, 1.52).ConclusionsIn this population, increased dietary selenium intake was associated with an increased risk of type 2 diabetes. These findings raise additional concerns about the association of selenium intake above the Recommended Dietary Allowance (55 μg/day) with diabetes risk.

Serum Selenium Concentrations and Hypertension in the US Population

Background—Selenium is an antioxidant micronutrient with potential interest for cardiovascular disease prevention. Few studies have evaluated the association between selenium and hypertension, with inconsistent findings. We explored the relationship of serum selenium concentrations with blood pressure and hypertension in a representative sample of the US population. Methods and Results—We undertook a cross-sectional analysis of 2638 adults ≥40 years old who participated in the 2003 to 2004 National Health and Nutrition Examination Survey. Serum selenium was measured by inductively coupled plasma-dynamic reaction cell-mass spectrometry. Hypertension was defined as blood pressure ≥140/90 mm Hg or current use of antihypertensive medication. Mean serum selenium was 137.1 μg/L. The multivariable adjusted differences (95% CIs) in blood pressure levels comparing the highest (≥150 μg/L) to the lowest (<122 μg/L) quintile of serum selenium were 4.3 (1.3 to 7.4), 1.6 (−0.5 to 3.7), and 2.8 (0.8 to 4.7) mm Hg for systolic, diastolic, and pulse pressure, respectively. The corresponding odds ratio for hypertension was 1.73 (1.18 to 2.53). In spline regression models, blood pressure levels and the prevalence of hypertension increased with increasing selenium concentrations up to 160 μg/L. Conclusions—High serum selenium concentrations were associated with higher prevalence of hypertension. These findings call for a thorough evaluation of the risks and benefits associated with high selenium status in the United States.

Usefulness of Triglycerides-to–High-Density Lipoprotein Cholesterol Ratio for Predicting the First Coronary Event in Men

Overweight and obesity potentiate the development of cardiovascular risk factors but many doubts have arisen recently regarding their role in coronary events. We evaluated the predictive value of a surrogate maker of insulin resistance, the ratio of triglyceride (TG) to high-density lipoprotein (HDL), for the incidence of a first coronary event in men workers according to body mass index (BMI). We designed a case-control study of active subjects collected from a single factory through their annual health examination and medical reports. Case subjects included those with myocardial infarction, unstable angina pectoris, or subclinical myocardial ischemia detected through electrocardiographic abnormalities. The sample was constituted by 208 case and 2,080 control subjects (mean age 49.9 years, 49.6 to 50.2). General characteristics of case and control subjects were well matched. The TG/HDL ratio was significantly higher in case subjects compared to controls. Stratification of the sample revealed an increasing prevalence of case subjects and mean TG/HDL in each category of BMI. Multivariable analysis, adjusted by smoking, demonstrated that TG/HDL increased 50% the risk of a first coronary event (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.26 to 1.71), whereas low-density lipoprotein cholesterol values indicated a more moderate increased risk (OR 1.01, 95% CI 1.005 to 1.012); metabolic syndrome (OR 1.76, 95% CI 0.94 to 3.30) and hypertension (OR 1.50, 95% CI 0.81 to 2.79) did not reach statistical significance. The TG/HDL ratio was associated with a first coronary event in all categories of BMI. In conclusion, the TG/HDL ratio has a high predictive value of a first coronary event regardless of BMI.

Prevalence of Metabolic Syndrome in the Spanish Working Population: MESYAS Registry

INTRODUCTION AND OBJECTIVES To assess the prevalence of metabolic syndrome in the active Spanish working population and to describe differences related to work type. SUBJECTS AND METHOD Data were collected on 7256 individuals [82.4% male; mean age (SD), 45.4 (9.8) years] actively employed in a large car factory and a department store. Metabolic syndrome was diagnosed according to modified ATP-III criteria (using body mass index instead of waist circumference). RESULTS Overall, the prevalence of metabolic syndrome was 10.2%. When data were adjusted to match the age and gender of the general population (age range, 20-60 years), the prevalence was 5.8% (95% CI, 4.1%-7.6%). Moreover, it was significantly higher in men than women, at 8.7% (95% CI, 7.3%-10.0%) vs 3.0% (95% CI, 0.8%-5.1%), respectively. All the components of the metabolic syndrome were significantly more common in males, except a low HDL-cholesterol level. Prevalence increased with age and male gender (OR=1.7), obesity (OR=9.6), hypertension (OR=3.4), and diabetes (OR=15.4). The prevalence was highest in manual workers (11.8%), and lower in office workers (9.3%) and managers (7.7%), which indicates an inverse relationship with social class. The likelihood of presenting with metabolic syndrome, irrespective of age or gender, was highest in manual workers (OR=1.3). This phenomenon seemed to depend on the serum triglyceride level. CONCLUSIONS One in ten active workers had metabolic syndrome. The prevalence rose with age, male gender, and blood pressure, and was greatly increased by obesity and diabetes. Manual workers had the highest prevalence, whereas managers had a more favorable profile.

Serum Selenium and Peripheral Arterial Disease: Results From the National Health and Nutrition Examination Survey, 2003–2004

The authors conducted a cross-sectional study of the association of serum selenium with the prevalence of peripheral arterial disease among 2,062 US men and women 40 years of age or older participating in the National Health and Nutrition Examination Survey, 2003-2004. Serum selenium was measured by using inductively coupled plasma-dynamic reaction cell-mass spectrometry. Peripheral arterial disease was defined as an ankle-brachial blood pressure index <0.90. The age-, sex-, and race-adjusted prevalence of peripheral arterial disease decreased with increasing serum selenium (P for linear trend = 0.02), but there was an indication of an upturn in risk in the highest quartile of serum selenium. The fully adjusted odds ratios for peripheral arterial disease comparing selenium quartiles 2, 3, and 4 with the lowest quartile were 0.75 (95% confidence interval: 0.37, 1.52), 0.58 (95% confidence interval: 0.28, 1.19), and 0.67 (95% confidence interval: 0.34, 1.31), respectively. In spline regression models, peripheral arterial disease prevalence decreased with increasing serum selenium levels up to 150-160 ng/mL, followed by a gradual increase at higher selenium levels. The association between serum selenium levels and the prevalence of peripheral arterial disease was not statistically significant, although a U-shaped relation was suggested.

Low Hemoglobin A1c and Risk of All-Cause Mortality Among US Adults Without Diabetes

Background—Among individuals without diabetes, elevated hemoglobin A1c (HbA1c) has been associated with increased morbidity and mortality, but the literature is sparse regarding the prognostic importance of low HbA1c. Methods and Results—National Health and Nutrition Examination Survey III (NHANES III) participants, 20 years and older, were followed up to 12 years (median follow-up, 8.8 years) for all-cause mortality. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between HbA1c levels and all-cause mortality for 14 099 participants without diabetes. There were 1825 deaths during the follow-up period. Participants with a low HbA1c (<4.0%) had the highest levels of mean red blood cell volume, ferritin, and liver enzymes and the lowest levels of mean total cholesterol and diastolic blood pressure compared with their counterparts with HbA1c levels between 4.0% and 6.4%. An HbA1c <4.0% versus 5.0% to 5.4% was associated with an increased risk of all-cause mortality (HR, 3.73; 95% CI, 1.45 to 9.63) after adjustment for age, race-ethnicity, and sex. This association was attenuated but remained statistically significant after further multivariable adjustment for lifestyle, cardiovascular factors, metabolic factors, red blood cell indices, iron storage indices, and liver function indices (HR, 2.90; 95% CI, 1.25 to 6.76). Conclusions—In this nationally representative cohort, low HbA1c was associated with increased all-cause mortality among US adults without diabetes. Additional research is needed to confirm these results and identify potential mechanisms that may be underlying this association.