scholarly journals Metabolic Syndrome Risk Among Adults Living with Sickle Cell Disease

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3405-3405 ◽  
Author(s):  
Shawn M Bediako ◽  
Julie Nelson ◽  
Cody Cichowitz ◽  
Tiffany Yu ◽  
C. Patrick Carroll ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Fasting Glucose ◽  
Fold Increase ◽  
Cell Disease

Abstract Background: The life span of individuals living with sickle cell disease (SCD) has increased considerably over the past three decades. Yet, as this group ages, new concerns emerge about their overall health profile - particularly with regard to cardiovascular disease (CVD), the primary cause of mortality in the United States. Metabolic syndrome (MetS) is a cluster of conditions that are associated with a 2-fold increase in CVD outcomes and a 1.5-fold increase in all-cause mortality. Little is known, however, about the prevalence of MetS risk factors among adults with SCD. As part of exploring the CVD profile of this population, we report findings from a pilot study that sought to evaluate MetS (typically defined as the presence of 3 or more risk factors). Methods: 49 adults (ages 21-66 years; 72% female) completed demographic and health behavior surveys, health-related family and personal histories, anthropometric measurements, the Block 2005 nutritional assessment, and a comprehensive blood panel. In terms of SCD genotype, 63% of participants were diagnosed with homozygous sickle cell anemia and 37% were diagnosed with hemoglobin SC disease. Descriptive and inferential statistics were used to summarize and compare MetS components stratified in separate analyses by genotype and sex. Results: The most prevalent MetS risk factors observed in our study - large waist circumference and reduced HDL levels - affected 45% and 69% of the sample, respectively. Overall, 16% of participants met traditional criteria for MetS. Table 1 summarizes mean values and shows the gender-adjusted risk for MetS. Although 78% of the sample self-reported moderate to high physical activity, nearly half of participants were overweight and had dietary saturated fat intake levels that exceeded both the national average and US Dietary Guidelines (<10%). Participants with the SC phenotype were older, consumed more calories, and had higher BMI, waist circumference, and BP values compared to those with the SS phenotype. Overall, males had worse MetS risk profiles compared to women, but no statistically significant sex differences were observed with regard to components of MetS. Conclusion: We report prevalence of MetS components, a surrogate of CVD risk, in a sample of adults living with SCD. Despite high levels of self-reported physical activity, both increased waist circumference and reduced HDL levels were notably high in our sample. These findings correspond with recent studies that indicate an upward trend in obesity and BMI among young adults with SCD. They also suggest a need to prioritize weight management, aerobic exercise, and resistance training strategies that could decrease MetS risk, but are rarely considered for this population. Table 1. Metabolic syndrome risk among adults living with SCD (N=49) Mean Value (SD) Proportion at Risk* Male (n = 14) Female (n = 35) Male (n = 14) Female (n = 35) Age (years) 41.6 (10.76) 39.3 (12.86) - - Waist circumference (cm) 96.53 (21.99) 90.75 (14.05) 42.9% 45.7% Triglycerides (mg/dL) 114.21 (57.22) 83.36 (36.21) 21.4% 3.0% HDL (mg/dL) 35.07 (9.51) 51.30 (20.31) 78.6% 69.7% Systolic BP 115.79 (15.00) 108.59 (13.15) 21.4% 8.6% Diastolic BP 69.11 (8.99) 62.17 (6.18) 0.0% 0.0% Fasting Glucose (mg/dL) 86.50 (8.07) 80.91 (13.73) 0.0% 9.0% Metabolic Syndrome - - 28.6% 8.6% *"Risk" is defined as: waist circumference > 89cm (Females) and > 102cm (Males); triglyceride levels > 150mg/dL; HDL levels < 50mg/dL (Females) and < 40mg/dL (Males); systolic blood pressure > 130; diastolic blood pressure > 85; fasting glucose levels > 100mg/dL. Disclosures No relevant conflicts of interest to declare.

The Effects of an Incremental Approach to 10,000 Steps/Day on Metabolic Syndrome Components in Sedentary Overweight Women

2010 ◽  
Vol 7 (6) ◽  
pp. 737-745 ◽  
Author(s):  
Anthony Musto ◽  
Kevin Jacobs ◽  
Mark Nash ◽  
Gianluca DelRossi ◽  
Arlette Perry
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Heart Rate ◽  
Waist Circumference ◽  
Systolic Blood Pressure ◽  
Fasting Glucose ◽  
Resting Heart Rate ◽  
Overweight Women ◽  
Metabolic Syndrome Components

Background:Pedometer programs can increase physical activity in sedentary individuals, a population that is at risk for developing metabolic syndrome and each of its individual components. Although the popular 10,000 steps/day recommendation has shown to induce many favorable health benefits, it may be out of reach for sedentary individuals. This study observed the effects of incremental increases in steps/day on metabolic syndrome components in sedentary overweight women.Methods:This study was a longitudinal, quasiexperimental design. Participants were recruited from a 12-week work-site pedometer program and grouped as either ‘active’ or ‘control’ after the intervention based on their steps/day improvement. Self-reported physical activity, pedometer assessed physical activity, BMI, resting heart rate, waist circumference, blood pressure, triglycerides, HDLC, and fasting glucose were measured before and after the program.Results:The active group showed significant within-group improvements in waist circumference and fasting glucose. Significant group differences were observed in resting heart rate, BMI, and systolic blood pressure; however, the changes observed in systolic blood pressure were not independent of weight loss.Conclusions:Incremental increases in steps/day induced favorable changes in some MetS components suggesting that this approach is a viable starting point for sedentary individuals that may find it difficult to initially accumulate 10,000 steps/day.

Abstract P419: Association Between Physical Activity and Risk Factors for Metabolic Syndrome in a Sample of HIV+ Men and Women Currently Taking Antiretroviral Therapy

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Jason R Jaggers ◽  
Gregory A Hand ◽  
Vivek Prasad ◽  
Xuemei Sui ◽  
Stephanie Burgess ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Metabolic Syndrome ◽  
Antiretroviral Therapy ◽  
Waist Circumference ◽  
Fasting Glucose ◽  
Pearson Correlation ◽  
People Living With Hiv ◽  
Glucose Levels ◽  
Living With Hiv

Background: Metabolic Syndrome (MetSyn) is a strong predictor of type 2 diabetes and cardiovascular disease (CVD). Recent data show that people living with HIV/AIDS (PLWHA) are at a greater risk of CVD, which could possibly be explained by an increased prevalence of MetSyn as a result of the metabolic disturbances known to be associated with antiretroviral therapy (ART). The purpose of this study is to examine the relationships among physical activity (PA) and risk factors for MetSyn in a sample of HIV+ adults currently taking ART. Methods: A total of 32 males and 38 females living with HIV and currently taking ART were enrolled in an ongoing PA intervention aimed to reduce risk factors for CVD. Clinical assessments included measures of resting blood pressure (BP), waist circumference, height, weight, PA levels via accelerometer, and a fasted blood draw. Inactivity was defined as measured activity < 3 metabolic equivalents (METS) or if the person was sedentary, whereas moderate to vigorous PA was defined as any activity ≥ 3 METS. Accelerometer data was considered valid if the participant had a total on-body time of at least 10 hours a day for 4 days. Levels of PA were divided into 4 quartiles (Q1=0-40 mins of PA; Q2=40-80 mins; Q3=80-160 mins; Q4≥160mins). A one-way ANOVA was used to determine differences between quartiles. Results: Waist circumference was significantly lower across PA quartiles (p < 0.001). A similar pattern was observed in fasting glucose levels; however the results were not significant. Pearson correlation showed a significant association between PA and waist circumference (r = - 0.526; p < 0.001), but not BP or fasting glucose. Although fasting glucose was not significantly associated with PA, the Pearson correlation did show a significant association between inactivity and fasting glucose (r = 0.433; p = 0.019). Conclusions: These data show that greater amounts of PA are significantly associated with a smaller waist circumference for PLWHA who currently took ART. A significant relationship was also observed among inactivity and fasting glucose. In conclusion, routine PA can be beneficial in helping PLWHA reduce waist circumference and decrease sedentary time ultimately leading to a reduction in fasted glucose levels. This in turn would help PLWHA self-manage known risk factors for MetSyn, thus reducing their risk of CVD.

scholarly journals Individual Diet Modification Reduces the Metabolic Syndrome in Patients Before Pharmacological Treatment

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2102
Author(s):  
Małgorzata Elżbieta Zujko ◽  
Marta Rożniata ◽  
Kinga Zujko
Keyword(s):  
Physical Activity ◽  
Metabolic Syndrome ◽  
Fatty Acids ◽  
Waist Circumference ◽  
Nutrition Education ◽  
Dietary Habits ◽  
Fasting Glucose ◽  
Intervention Group ◽  
Control Group ◽  
The Metabolic Syndrome

Modification of lifestyle, including healthy nutrition, is the primary approach for metabolic syndrome (MetS) therapy. The aim of this study was to estimate how individual nutrition intervention affects the reduction of MetS components. Subjects diagnosed with MetS were recruited in the Lomza Medical Centre. The study group consisted of 90 participants and was divided into one intervention group (individual nutrition education group (INEG)) and one control group (CG). The research was conducted over 3 months. The following measurements were obtained during the first visit and after completion of the 3 months intervention: body mass, waist circumference, body composition, blood pressure, fasting glucose, and blood lipids. Dietary assessments were performed before and post-intervention using 3-day 24-h dietary recalls. Dietary knowledge was evaluated with the KomPAN questionnaire. The total polyphenol content of the diet was calculated. Sociodemographic and lifestyle characteristics were collected from a self-reported questionnaire. The physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ). It was found that the individual nutrition education was an effective method to improve the knowledge, dietary habits, and physical activity of the study participants. The modification of the diet in terms of higher intake of polyphenols (flavonoids and anthocyanins), fiber, polyunsaturated fatty acids (PUFA), PUFA n-3, and lower intake of saturated fatty acids (SFA) had a significant impact on the improvement of some MetS risk factors (waist circumference, fasting glucose, and HDL-cholesterol).

scholarly journals Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 84
Author(s):  
Jeanne Sigalla ◽  
Nathalie Duparc Alegria ◽  
Enora Le Roux ◽  
Artemis Toumazi ◽  
Anne-Françoise Thiollier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neuropathic Pain ◽  
Sickle Cell Disease ◽  
Sex Ratio ◽  
Prospective Study ◽  
Sickle Cell ◽  
Clinical Presentation ◽  
Early Stage ◽  
Cell Disease ◽  
A Prospective Study

The majority of hospitalizations of patients with sickle cell disease (SCD) are related to painful vaso-occlusive crises (VOCs). Although the pain of VOC is classically nociceptive, neuropathic pain (NP) has also been demonstrated in SCD patients. The aim of our study is to specify the prevalence of NP during VOCs in SCD children using a dedicated scale and to measure its characteristics. We performed a prospective study that included SCD children hospitalized for an acute VOC. The presence of NP was sought with the DN4 scale on the second and fourth days of hospitalization. A total of 54 SCD children were included in the study. Overall, 41% of the patients (n = 22) experienced neuropathic pain during the VOC, mostly at an early stage (Day 2). The median age, the sex ratio, the location of the pain, and the morphine consumption were similar for patients with and without NP. Our study shows that neuropathic pain is very common during VOCs in SCD children. The absence of identified risk factors should prompt us to be vigilant regardless of the patient’s age, sex, and clinical presentation.

scholarly journals Normal Non-HDL Cholesterol, Low Total Cholesterol, and HDL Cholesterol Levels in Sickle Cell Disease Patients in the Steady State: A Case-Control Study of Tema Metropolis

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Richard K. D. Ephraim ◽  
Patrick Adu ◽  
Edem Ake ◽  
Hope Agbodzakey ◽  
Prince Adoba ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Steady State ◽  
Sickle Cell Disease ◽  
Total Cholesterol ◽  
Sickle Cell ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lipoprotein Cholesterol ◽  
Cell Disease ◽  
Cross Sectional

Background.Abnormal lipid homeostasis in sickle cell disease (SCD) is characterized by defects in plasma and erythrocyte lipids and may increase the risk of cardiovascular disease. This study assessed the lipid profile and non-HDL cholesterol level of SCD patients.Methods.A hospital-based cross-sectional study was conducted in 50 SCD patients, in the steady state, aged 8–28 years, attending the SCD clinic, and 50 healthy volunteers between the ages of 8–38 years. Serum lipids were determined by enzymatic methods and non-HDL cholesterol calculated by this formula: non-HDL-C = TC-HDL-C.Results.Total cholesterol (TC) (p=0.001) and high-density lipoprotein cholesterol (HDL-C) (p<0.0001) were significantly decreased in cases compared to controls. The levels of non-HDL-C, low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were similar among the participants. The levels of decrease in TC and HDL were associated with whether a patient was SCD-SS or SCD-SC. Systolic blood pressure and diastolic blood pressure were each significantly associated with increased VLDL [SBP,p=0.01, OR: 0.74 (CI: 0.6–0.93); DBP,p=0.023, OR: 1.45 (CI: 1.05–2.0)].Conclusion.Dyslipidemia is common among participants in this study. It was more pronounced in the SCD-SS than in SCD-SC. This dyslipidemia was associated with high VLDL as well as increased SBP and DBP.

The Relationship Between Objectively Measured Physical Activity, Salivary Cortisol, and the Metabolic Syndrome Score in Girls

2014 ◽  
Vol 26 (3) ◽  
pp. 221-230 ◽  
Author(s):  
Katrina D. DuBose ◽  
Andrew J. McKune
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Body Fat ◽  
Salivary Cortisol ◽  
Sexual Maturity ◽  
Vigorous Physical Activity ◽  
The Metabolic Syndrome ◽  
The Relationship

The relationship between physical activity levels, salivary cortisol, and the metabolic syndrome (MetSyn) score was examined. Twenty-three girls (8.4 ± 0.9 years) had a fasting blood draw, waist circumference and blood pressure measured, and wore an ActiGraph accelerometer for 5 days. Saliva samples were collected to measure cortisol levels. Previously established cut points estimated the minutes spent in moderate, vigorous, and moderate-to-vigorous physical activity. A continuous MetSyn score was created from blood pressure, waist circumference, high-density-lipoprotein (HDL), triglyceride, and glucose values. Correlation analyses examined associations between physical activity, cortisol, the MetSyn score, and its related components. Regression analysis examined the relationship between cortisol, the MetSyn score, and its related components adjusting for physical activity, percent body fat, and sexual maturity. Vigorous physical activity was positively related with 30 min post waking cortisol values. The MetSyn score was not related with cortisol values after controlling for confounders. In contrast, HDL was negatively related with 30 min post waking cortisol. Triglyceride was positively related with 30 min post waking cortisol and area under the curve. The MetSyn score and many of its components were not related to cortisol salivary levels even after adjusting for physical activity, body fat percentage, and sexual maturity.

scholarly journals Clinical and Biomarker Predictors for Avascular Necrosis in Sickle Cell Disease

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3091-3091
Author(s):  
Michael Rabaza ◽  
Maria Armila Ruiz ◽  
Liana Posch ◽  
Faiz Ahmed Hussain ◽  
Franklin Njoku ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sickle Cell Disease ◽  
Board Of Directors ◽  
Avascular Necrosis ◽  
Sickle Cell ◽  
Research Funding ◽  
Medical Attention ◽  
Cell Disease ◽  
Advisory Committees ◽  
Early Management

Abstract Introduction Sickle cell disease (SCD) affects 1 in 365 African Americans and approximately 25 million people world-wide. A common skeletal system complication is avascular necrosis (AVN), which can cause substantial pain and a reduced quality of life. While early management of AVN is focused on increasing range of motion with physical therapy and pain relief, there are no clear predictors for who is more likely to develop AVN and earlier institution of these preventive measure could help decrease disease progression. Vascular endothelial growth factor (VEGF) is a biomarker of endothelial injury and may indicate reduced vascular supply to the femoral or humeral head. Here we describe potential risk factors and biologic pathways for AVN in SCD, as understanding these may lead to improvements in future monitoring, early detection, and early intervention practices. Methods We investigated clinical and laboratory risk factors associated with AVN in a cohort of 435 SCD patients from our center. Blood samples, clinical, and laboratory data were collected at the time of enrollment during a clinic visit. Genotyping for alpha thalassemia was performed by PCR and the serum concentration of VEGF was measured by ELISA. AVN status was confirmed by review of the medical record and available imaging. We conducted a cross-sectional analysis comparing categorical and linear variables by AVN status using the chi-square and Kruskal-Wallis test, respectively. The independent association of the clinical and laboratory variables with AVN status was determined by logistic regression analysis. The initial model included variables with a P-value &lt; 0.1 on univariate analysis and the final model was ascertained by stepwise forward and backward selection. Median values and interquartile range (IQR) are provided. Results The median age of the cohort was 32 (IQR, 24 - 43) years, 57% (250/435) were female, and 46% (198/435) were on hydroxyurea. AVN was observed in 34% (149/435) of SCD patients. SCD patients with AVN were older, had more frequent vaso-occlusive crises requiring medical attention, and had a higher body mass index (Table I) (P ≤ 0.002). We measured VEGF in 241 of the SCD patients with serum samples available at the time of enrolment. Serum VEGF concentrations trended higher in SCD patients with versus without AVN (420 vs. 359 pg/mL, respectively; P = 0.078). In the multivariate analysis model, AVN was independently associated with increased number of vaso-occlusive crises (OR 1.1, 95% CI: 1.0 - 1.14; P = 0.02), AST concentration (natural log OR 0.5, 95% CI: 0.2 - 0.9; P = 0.03), VEGF concentration (natural log OR 1.4, 95% CI: 1.0 - 1.9; P = 0.047), and tobacco use (OR 1.9, 95% CI: 0.9 - 3.7; P = 0.078). Discussion In conclusion, we demonstrate a high prevalence of AVN in an adult cohort of SCD patients. The presence of AVN was independently associated with a greater frequency of vaso-occlusive pain episodes, which may demonstrate a shared pathophysiology between AVN and vaso-occlusion that merits further investigation. We demonstrate that serum VEGF concentrations are higher in SCD patients with AVN and may be a clinical tool to identify those at high-risk and for earlier intervention for this complication. Figure 1 Figure 1. Disclosures Gordeuk: Modus Therapeutics: Consultancy; Novartis: Research Funding; Incyte: Research Funding; Emmaus: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; CSL Behring: Consultancy. Saraf: Pfizer: Research Funding; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals Alkaline Phosphatase Is Associated with Red Cell Alloimmunization in the Pulmonary Hypertension and Hypoxic Response (PUSH) Sickle Cell Disease Cohort

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 20-20
Author(s):  
Victoria Brooks ◽  
Oluwalonimi Adebowale ◽  
Victor R. Gordeuk ◽  
Sergei Nekhai ◽  
James G. Taylor
Keyword(s):  
Risk Factors ◽  
Alkaline Phosphatase ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Research Funding ◽  
Severe Disease ◽  
Case Control ◽  
Red Cell ◽  
Cell Disease ◽  
History Of

Background: Blood transfusion is a common therapy for sickle cell disease (SCD). Although, highly effective, a major limitation is development of alloantibodies to minor blood group antigens on donor red cells. Alloimmunization has a prevalence of 2-5% for transfusions in the general population, but it is significantly higher in SCD. Risk factors for alloimmunization have been poorly characterized, although number of lifetime transfusions is an important risk factor. Alloimmunization has been clinically observed in children with a prevalence of about 7%. With development of each antibody, blood donor matching becomes increasingly difficult and expensive with an increased risk for transfusion reactions and diminished availability of compatible red cell units for treatment of SCD. The ability to identify risk factors for developing alloantibodies would be beneficial for clinicians. To identify markers for alloimmunization in SCD, we have analyzed children and adults who developed this complication. Methods: We analyzed The Pulmonary Hypertension and Hypoxic Response in Sickle Cell Disease (PUSH) study, which enrolled n=468 pediatric and n=59 adult SCD subjects. In both children and adults, alloimmunization cases were defined as a history of at least 1 alloantibody. Controls in both cohorts were defined as subjects with no history of alloantibodies and receipt of more than 10 lifetime red cell transfusions. All others within the study who did not meet these criteria were assigned to a third comparison group. To identify differences between cases, controls and all others, we performed univariate analyses (using ANOVA or Kruskal Wallace where appropriate) for clinical parameters and laboratories. Case control comparisons were also performed for selected variables and plasma levels for 11 cytokines. Results were further analyzed using regression modeling. Results: The overall prevalence of alloimmunization was 7.3% among children (34/468 subjects; median age 12, range 3-20 years) compared to 28.8% in adults (17/59 subjects; median age 37, range 18-73 years). When only considering those with &gt;10 lifetime transfusions, the prevalence was considerably higher at 29.3% and 54.8% in children and adults, respectively. At the same time, 8 pediatric (23.5%) and 5 adult (29.4%) alloimmunization cases had received fewer than 10 transfusions. In a 3-way pediatric cohort comparison (cases, controls and all others), risk factors associated with alloimmunization included SS genotype, older age and markers of more severe disease (higher ferritin, WBCs, platelets and total bilirubin). Comparison of cases to controls showed alkaline phosphatase (P=0.05) was significantly lower in cases, whereas AST (P=0.02) was significantly higher even with adjustment for age. Levels of plasma cytokines MCP-1 (P=0.01) and IFNgamma (P=0.08) were lower in cases from a subset of the pediatric cohort. In adults, only 4/59 (6.8%) subjects had never received a lifetime transfusion (all non-SS). In the adult 3-way comparisons, only SS genotype and higher ferritin were associated with alloimmunization. The adult case control analysis showed higher absolute monocyte count (P=0.02), absolute eosinophil count (P=0.04) and absolute basophil count (P=0.008) in association with alloimmunization cases. In addition, alkaline phosphatase was again significantly lower among cases (P=0.02) as seen in the pediatric cohort. There were no significant differences in cytokine levels among adults. Conclusions: When considering only transfused SCD patients, the prevalence of alloimmunization is higher than 30%. As seen in prior studies, higher lifetime red cell transfusions are an important risk factor especially among adults where most patients have received transfusions. Children who develop alloantibodies appear to have laboratory markers of more severe disease, but this is not observed in adults. A novel association observed across both pediatric and adult subjects is a significantly lower serum alkaline phosphatase in those with alloantibodies. The results of this study suggest a need for improved tracking of red cell transfusion therapy in the US for SCD patients due to a high prevalence of alloimmunization. Further study is also needed to elucidate the significance of the alkaline phosphatase association. Disclosures Gordeuk: CSL Behring: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; Novartis: Consultancy; Ironwood: Research Funding; Imara: Research Funding.

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