Age-specific diabetes risk by the number of metabolic syndrome components: a Korean nationwide cohort study

Abstract Background Metabolic syndrome is associated with an increased risk of diabetes. This study investigated the associations between the number of metabolic syndrome components and diabetes risk by age, sex and BMI. Methods Data for 19,475,643 participants ≥ 20 years old with no history of diabetes were obtained between 2009 and 2012 and were accessed using the South Korean National Health Insurance Service. Metabolic syndrome was defined according to the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III. We assessed the risk of diabetes according to the number of metabolic syndrome components after stratifying the study participants into groups by age (20–39, 46–64, ≥ 65 years), sex, and BMI (below or above 25). Results During an average of 5.13 years of follow-up, the incidence rates of diabetes increased with the number of metabolic syndrome components. Age and BMI gradually increased with the number of metabolic syndrome components. The multivariable-adjusted hazard ratios (HRs) for incident diabetes were 1.401, 1.862, 2.47, 3.164 and 4.501 for participants with one through five components, respectively, compared with those without metabolic syndrome components. The risk of diabetes was 1.79-, 2.18-, and 3.05-times higher for participants ≥ 65 years; 2.57-, 3.45-, and 5.18-times higher for participants 40–64 years; and 2.55-, 3.89-, and 6.31-times higher for participants 20–39 years of age with three through five components, respectively, compared to those with no components. There was no difference in the risk of diabetes between men and women. The HRs were 5.63 for participants with a BMI ≥ 25 and 3.98 for those with a BMI < 25 among individuals with five components. Conclusions The risk of diabetes was more strongly associated with the number of metabolic syndrome components among younger adults. In addition, the risk of diabetes across the number of metabolic syndrome components was greater in participants with a BMI ≥ 25.

Download Full-text

Abstract P442: Periodontal Disease is Associated With Risk of Incident Diabetes Among Non-obese Individuals

Circulation ◽

10.1161/circ.141.suppl_1.p442 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Hamdi S Adam ◽

Shaoping Zhang ◽

Kamaira Philips ◽

Kevin Moss ◽

Di Wu ◽

...

Keyword(s):

Periodontal Disease ◽

Disease Status ◽

Incidence Rates ◽

Normal Weight ◽

Self Report ◽

Incident Diabetes ◽

Incident Type ◽

Hazard Ratios ◽

Increased Risk ◽

Study Participants

Background: Strong evidence suggests that diabetes is a risk factor for periodontal disease and that periodontal disease, once established in the diabetic state, then contributes to worsened glycemic control. Recent studies suggest that periodontal disease is also associated with diabetes development. Hypothesis: Incident Type 2 Diabetes (T2D) rates will be higher among participants with baseline periodontal disease vs. those with periodontal health. The relationship is modified by Body Mass Index (BMI). Methods: We included 5586 diabetes-free eligible participants (aged 52-75 years) from Visit 4 (1996-1999) of The Atherosclerosis Risk in Communities (ARIC) Study. Participants received full-mouth periodontal exams and periodontal disease status was classified using Periodontal Profile Classes (PPC-Stages). T2D was defined based on participant-self report of physician diagnosis during annual telephone follow-ups. Time-to-event was computed from baseline through 2018. Competing risk, multivariable Cox proportional hazard models examined T2D and All-Cause Mortality risk according to baseline periodontal disease status. We tested the interaction with BMI. Multivariable adjustment was performed for race/center, age, gender, smoking and education. Results: Participants were mean age (SD) 62.4 (5.6), 55.0% female, 16.7% African American. During the average 21.1 years of follow-up there were 1,359 incident T2D cases and 1,531 deaths. Cumulative incidence rates were 24.3% and 27.4% for T2D and deaths, respectively. Among underweight participants, the hazard ratios[95%Cis] for incident diabetes among severe periodontitis or severe tooth loss (vs. periodontally healthy) were 1.84[1.14-2.96] and 2.29[1.57-3.33], respectively. Hazard ratios[95%Cis] among normal weight participants were 1.54[1.06-2.23] and 1.88[1.41-2.51], respectively. There were no significant associations with T2D in obese participants (p for interaction = 0.06. Conclusion: Severe periodontal disease was associated with a modestly increased risk for T2D among a multi-racial community-based sample. Two periodontal disease stages in the PPC-Stages index system are significantly associated with increased risk for incident diabetes. This periodontal disease-associated risk is modified by BMI levels and only associated with incident diabetes in study participants with lower BMI.

Download Full-text

Metabolic Syndrome and Risk of Lung Cancer: An Analysis of Korean National Health Insurance Corporation Database

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa596 ◽

2020 ◽

Vol 105 (11) ◽

Cited By ~ 1

Author(s):

Sooim Sin ◽

Chang-Hoon Lee ◽

Sun Mi Choi ◽

Kyung-Do Han ◽

Jinwoo Lee

Keyword(s):

Lung Cancer ◽

Metabolic Syndrome ◽

Health Insurance ◽

National Health Insurance ◽

National Health ◽

Screening Program ◽

Increased Risk ◽

Korean National Health Insurance ◽

The Impact ◽

Metabolic Syndrome Components

Abstract Introduction Metabolic syndrome is known to increase the risk of several cancers. However, the association between lung cancer and metabolic syndrome remains unclear. Thus, we investigated the impact of metabolic syndrome on the incidence of lung cancer. Methods This study enrolled participants in a health screening program provided by the Korean National Health Insurance Service between January 2009 and December 2012. The incidence of lung cancer was observed until December 2016. We analyzed the risk of lung cancer according to the presence of metabolic syndrome, metabolic syndrome components, and number of metabolic syndrome components. Results During the study, 45 635 new cases of lung cancer were recorded among 9 586 753 participants. The presence of metabolic syndrome and all its components was positively associated with the risk of lung cancer in men after multivariate adjustment (hazard ratio [HR] of metabolic syndrome 1.15; 95% confidence interval [CI], 1.12-1.18). The risk of lung cancer increased with the number of components present. The effect of metabolic syndrome on the increasing risk of lung cancer is may be higher in underweight male ever-smokers than in other participants. Conclusion Metabolic syndrome was associated with an increased risk of lung cancer in men. Moreover, the higher the number of metabolic syndrome components, the higher the risk of lung cancer.

Download Full-text

Increased Risk of Retinal Vasculitis in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.739883 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiao-Huan Chen ◽

Jia-Cheng Shi ◽

James Cheng-Chung Wei ◽

Hsin-Hua Chen ◽

Han-You Mo

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Retinal Vasculitis ◽

Population Based ◽

Incidence Rates ◽

Sensitivity Analyses ◽

Systemic Lupus ◽

Hazard Ratios ◽

Increased Risk ◽

Study Participants

Objectives: To evaluate the relationship between systemic lupus erythematosus (SLE) and the risk of retinal vasculitis (RV) using a population-based database.Methods: Using the 1997–2013 Taiwanese National Health Insurance Database, we identified newly diagnosed SLE patients between 2001 and 2012 as the SLE group. We matched the SLE group with non-SLE individuals selected from a representative one million sample of the population in a 1:20 ratio for age, sex, and the year of the index date. After adjusting for potential confounders, including urbanization of the patient's residence, the level of the payroll-related insured amount, and selected comorbidities, we examined the association between SLE and the risk of RV using the Cox proportional hazard model shown as hazard ratios (HRs) with 95% confidence intervals (CIs). Sensitivity analyses were conducted using various definitions of RV.Results: We included 11,586 patients with SLE and 231,720 matched non-SLE individuals. The mean age of the study participants was 36.7 ± 16.9 years, and the female-to-male ratio was 6.8:1. The incidence rates of RV were 56.39 cases per 100,000 person-years and 2.45 cases per 100,000 person-years, respectively. After adjusting for potential confounders, the incidence rate of RV in the SLE cohort was 22.99 times higher than that in the non-SLE cohort (56.39 vs. 2.45 per 100,000 person-years). The adjusted HR for RV in the SLE group was 23.61 (95% CI, 14.94–37.32). The results remained robust in the sensitivity analysis.Conclusion: This nationwide population-based study revealed that SLE patients had a significantly higher risk of RV than non-SLE individuals.

Download Full-text

Association of breastfeeding and risk of metabolic syndrome and its components in postmenopausal parous women: Korea national health and nutrition examination survey (2010 ~ 2016)

Archives of Public Health ◽

10.1186/s13690-021-00607-2 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Jusuk Lee ◽

Taehong Kim

Keyword(s):

Metabolic Syndrome ◽

Laboratory Data ◽

Multivariate Logistic Regression Analysis ◽

Density Lipoprotein ◽

Cross Sectional Study ◽

Korean Women ◽

Cross Sectional ◽

Increased Risk ◽

Nationally Representative ◽

Study Participants

Abstract Background Understanding the relationship between breastfeeding (BF) and metabolic syndrome (Mets) is important for maternal long-term health benefits and disease prevention. This study aimed to examine the association between BF and Mets and its components among postmenopausal parous Korean women. Methods This cross-sectional study on 10,356 Korean women used nationally representative data from the KNHANES from 2010 to 2016. Anthropometric, laboratory data and manual BP were measured. A multivariate logistic regression analysis was conducted to examine the association of BF with Mets and its components after adjusting for potential confounding variables. A p-value < 0.05 was to be considered statistically significant. Results Mets was present in 42% of the study participants. The BF group had low household income and education level. The prevalence of Mets in the BF group was higher than that in the non-BF group (42.69% vs. 34.76%, p < 0.001). BF was associated with increased risk of Mets (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 1.18–1.65, p < 0.001). The BF group was at higher risks for diabetes (OR: 1.5, 95%CI: 1.14–1.98), hypertension (OR: 1.32, 95%CI: 1.03–1.68), hypertriglyceridemia (OR: 1.42, 95%CI: 1.02–1.99) and low high-density lipoprotein cholesterol (OR: 1.32, 95%CI: 1.06–1.65). Conclusion In this study, BF did not affect decreasing the prevalence of Mets and its components.

Download Full-text

Changes in Metabolic Syndrome Status and Breast Cancer Risk: A Nationwide Cohort Study

Cancers ◽

10.3390/cancers13051177 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1177

Author(s):

In Young Choi ◽

Sohyun Chun ◽

Dong Wook Shin ◽

Kyungdo Han ◽

Keun Hye Jeon ◽

...

Keyword(s):

Breast Cancer ◽

Metabolic Syndrome ◽

Proportional Hazards ◽

Screening Program ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Increased Risk ◽

Health Screening Program ◽

Design And Methods

Objective: To our knowledge, no studies have yet looked at how the risk of developing breast cancer (BC) varies with changes in metabolic syndrome (MetS) status. This study aimed to investigate the association between changes in MetS and subsequent BC occurrence. Research Design and Methods: We enrolled 930,055 postmenopausal women aged 40–74 years who participated in a biennial National Health Screening Program in 2009–2010 and 2011–2012. Participants were categorized into four groups according to change in MetS status during the two-year interval screening: sustained non-MetS, transition to MetS, transition to non-MetS, and sustained MetS. We calculated multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for BC incidence using the Cox proportional hazards models. Results: At baseline, MetS was associated with a significantly increased risk of BC (aHR 1.11, 95% CI 1.06–1.17) and so were all of its components. The risk of BC increased as the number of the components increased (aHR 1.46, 95% CI 1.26–1.61 for women with all five components). Compared to the sustained non-MetS group, the aHR (95% CI) for BC was 1.11 (1.04–1.19) in the transition to MetS group, 1.05 (0.96–1.14) in the transition to non-MetS group, and 1.18 (1.12–1.25) in the sustained MetS group. Conclusions: Significantly increased BC risk was observed in the sustained MetS and transition to MetS groups. These findings are clinically meaningful in that efforts to recover from MetS may lead to reduced risk of BC.

Download Full-text

Incidence of VTE Among Patients with a Cancer Diagnosis in Oklahoma County

Blood ◽

10.1182/blood-2019-130604 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3463-3463

Author(s):

Micah Denay McCumber ◽

Aaron Mark Wendelboe ◽

Janis Campbell ◽

Kai Ding ◽

Michele G Beckman ◽

...

Keyword(s):

Native Americans ◽

Cancer Diagnosis ◽

Incidence Rates ◽

Cancer Type ◽

Surveillance Period ◽

Increased Risk ◽

History Of ◽

Race Ethnicity ◽

History Of Cancer ◽

Active Cancer

Background: Patients with cancer are at elevated risk for venous thromboembolism (VTE). Active cancer contributes a 4-7 fold increased risk for VTE; however, the incidence of VTE stratified by subpopulations of patients diagnosed with cancer, especially race/ethnicity, is uncertain. Objective: Describe the incidence of VTE among adult patients (age ≥ 18 years) with a cancer diagnosis in Oklahoma County, OK according to age, gender, race, and cancer type. Methods: In collaboration with the Centers for Disease Control and Prevention, we established a population-based surveillance system for VTE in Oklahoma County, OK between April 1, 2012-March 31, 2014 to estimate the incidences of first-time and recurrent VTE events. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. Active surveillance involved reviewing imaging studies (e.g., chest computed tomography and compression ultrasounds of the extremities) from all inpatient and outpatient facilities in the county and collecting demographic, treatment and risk factor data on all VTE case-patients. Patients were linked to the Oklahoma Central Cancer Registry. Any patient with a cancer diagnosis since 1997, excluding basal or squamous cell carcinoma, were included in the population-at-risk. Active cancer was defined as metastatic or a diagnosis ≤6 months before their VTE diagnosis. Poisson regression was used to estimate incidence rates (IRs) and 95% confidence intervals (CIs), which are reported per 1,000 person years (PY). Estimates with <10 events were suppressed. Results: Among all patients aged ≥18 years with a cancer diagnosis since 1997, 1.5% (n = 881) had a VTE event during the 2-year surveillance period. The overall annual age-adjusted incidence of VTE among those with cancer was 6.8 per 1,000 PY (95% CI: 5.81, 7.95). The demographic-specific incidence rates are summarized in Table 1. The VTE incidence did not significantly differ by sex. When stratified by age, annual VTE incidence was similar among those aged 18-39 years (6.1/1,000 PY, 95% CI: 4.35, 8.61), 40-59 years (6.2/1,000 PY, 95% CI: 5.4, 7.14), and 60-79 years (7.2/1,000 PY, 95% CI: 6.55, 7.90), however, the incidence was significantly higher (p<0.05) in those aged 80+ years (10.1/1,000 PY, 95% CI: 8.77, 11.61). When patients with a cancer diagnosis were stratified by race/ethnicity, non-Hispanic blacks had the highest VTE incidence (11.7/1,000 PY, 95% CI: 10.00, 13.59), followed by Hispanics (8.0/1,000 PY, 95% CI: 5.66, 11.44), non-Hispanic whites (6.9/1,000 PY, 95% CI: 6.41, 7.48), other non-Hispanic/unknown (5.8/1,000 PY, 95% CI: 3.45, 9.85), and non-Hispanic Native Americans (2.6/1,000 PY, 95% CI: 1.39, 4.79). VTE incidence was highest among those with active cancer or a history of cancer within the past three years, after which it appeared to decrease. When stratified by primary cancer type, VTE incidence was highest among those with brain cancer (16.6/1,000 PY, 95% CI: 11.06, 25.04) and lowest among those with prostate cancer (5.2/1,000 PY, 95% CI: 4.20, 6.44). As shown in Table 2, when stratified by cancer type, the incidence of VTE was higher (non-overlapping CIs) among those with active cancer compared to those with a history of cancer >6 months for several tumor types. Discussion: The incidence of VTE among those with cancer differs by race/ethnicity, with non-Hispanic blacks bearing the highest burden of disease. The risk of VTE persists and is particularly elevated up to three years after a cancer diagnosis. Disclosures Raskob: Eli Lilly: Consultancy; Pfizer: Consultancy, Honoraria; Portola: Consultancy; Novartis: Consultancy; BMS: Consultancy, Honoraria; Janssen R&D, LLC: Consultancy, Honoraria; Tetherex: Consultancy; Daiichi Sankyo: Consultancy, Honoraria; Anthos: Consultancy; Bayer Healthcare: Consultancy, Honoraria; Boehringer Ingelheim: Consultancy.

Download Full-text

Supper Timing and Cardiovascular Mortality: The Japan Collaborative Cohort Study

Nutrients ◽

10.3390/nu13103389 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3389

Author(s):

Jingyun Tang ◽

Jia-Yi Dong ◽

Ehab S. Eshak ◽

Renzhe Cui ◽

Kokoro Shirai ◽

...

Keyword(s):

Hemorrhagic Stroke ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Stroke Mortality ◽

Hazard Ratios ◽

Risk Of Mortality ◽

Increased Risk ◽

Study Participants

Evidence on the role of supper timing in the development of cardiovascular disease (CVD) is limited. In this study, we examined the associations between supper timing and risks of mortality from stroke, coronary heart disease (CHD), and total CVD. A total of 28,625 males and 43,213 females, aged 40 to 79 years, free from CVD and cancers at baseline were involved in this study. Participants were divided into three groups: the early supper group (before 8:00 p.m.), the irregular supper group (time irregular), and the late supper group (after 8:00 p.m.). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for stroke, CHD, and total CVD according to the supper time groups. During the 19-year follow-up, we identified 4706 deaths from total CVD. Compared with the early supper group, the multivariable HR of hemorrhagic stroke mortality for the irregular supper group was 1.44 (95% confidence interval [CI]: 1.05–1.97). There was no significant association between supper timing and the risk of mortality from other types of stroke, CHD, and CVD. We found that adopting an irregular supper timing compared with having dinner before 8:00 p.m. was associated with an increased risk of hemorrhagic stroke mortality.

Download Full-text

Hypertension Burden and the Risk of New-Onset Atrial Fibrillation

Hypertension ◽

10.1161/hypertensionaha.120.16659 ◽

2021 ◽

Vol 77 (3) ◽

pp. 919-928

Author(s):

So-Ryoung Lee ◽

Chan Soon Park ◽

Eue-Keun Choi ◽

Hyo-Jeong Ahn ◽

Kyung-Do Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Total Study Population ◽

Increased Risk ◽

Burden Scale ◽

History Of ◽

Study Population ◽

Korean National Health Insurance ◽

Stage 1 ◽

The Relationship

The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

Download Full-text

Abstract TP493: Herpes Zoster Vaccine Live And Risk For Stroke Among Medicare Beneficiaries: Population Based Matched Cohort Study

Stroke ◽

10.1161/str.51.suppl_1.tp493 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Quanhe YANG ◽

Anping Chang ◽

Xin Tong ◽

Robert Merritt

Keyword(s):

Herpes Zoster ◽

Hemorrhagic Stroke ◽

Population Based ◽

Racial Groups ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Zoster Vaccine ◽

Hazard Ratios ◽

Increased Risk ◽

History Of

Introduction: Herpes zoster (HZ) is associated with increased risk of stroke, and Zoster Vaccine Live (ZVL) reduces risk of HZ. No study examined the association between ZVL and risk for stroke. The present study examined this association among US older population. Methods: We included 1,382,051 Medicare fee-for-service beneficiaries age ≥66 years without a history of stroke and who received ZVL during 2008-2014, and 1,382,051 matched controls (using a comprehensive list of matching variables) without ZVL followed from ZVL receipt to December 31 2016. We used Cox proportional hazard models to examine the association between ZVL and composite fatal/non-fatal incident stroke outcomes. Results: During a median of 3.9 years follow-up (interquartile range 2.7-5.4), we documented 42,267 stroke events including 33,510 acute ischemic strokes (AIS) and 4,318 hemorrhagic strokes among beneficiaries who received ZVL over 5,890,113 person years. The corresponding numbers for controls were 48,139, 39,334, and 4,713 during 5,693,943 person years. Crude incidence comparing beneficiaries with and without ZVL were 7.18 vs. 8.45 per 1000 person years for all stroke, 5.40 vs. 6.53 for AIS, and 0.73 vs. 0.82 for hemorrhagic stroke (p<0.001 for difference). Adjusted hazard ratios comparing beneficiaries with ZVL to controls were 0.84 (95% CI 0.83-0.85), 0.82 (0.81-0.83), and 0.88 (0.84-0.91) for all stroke, AIS and hemorrhagic stroke respectively. The association between ZVL and risk for stroke appeared to be stronger among beneficiaries 66-79 years compared to those ≥80 years of age (p=0.020 for interaction), but largely consistent across sex, and racial groups. Conclusion: Among Medicare beneficiaries, receipt of ZVL was associated with lower incidence of stroke. Further study is needed to confirm our findings.

Download Full-text

Rapid-onset clozapine-induced hyperglycaemia: pathways of glycaemic dysregulation

BMJ Case Reports ◽

10.1136/bcr-2021-243938 ◽

2021 ◽

Vol 14 (9) ◽

pp. e243938

Author(s):

Mariana Barbosa ◽

Vera Fernandes

Keyword(s):

Parkinson’S Disease ◽

Metabolic Syndrome ◽

Parkinson's Disease ◽

Blood Glucose ◽

Glycaemic Control ◽

Glycated Haemoglobin ◽

Rapid Onset ◽

Proper Treatment ◽

Increased Risk ◽

History Of

Clozapine is an atypical antipsychotic used in refractory schizophrenia, also efficient in alleviating dyskinesia in Parkinson’s disease. Despite its potency, this drug is associated with severe metabolic side effects, including increased risk for diabetes. We report the case of a 45-year-old overweight woman with Parkinson’s disease who presented with rapid-onset hyperglycaemia within 2 months after starting clozapine for refractory dyskinaesia. She had a history of gestational diabetes. At presentation, her blood glucose level was 505 mg/dL and glycated haemoglobin 12.4%, with no catabolic symptoms. Clozapine was suspended and metformin was started, but adequate glycaemic control was achieved only with insulin therapy, along with exenatide and empagliflozin afterwards. We assume that clozapine acted as a trigger for rapid deterioration of glycaemic control through direct pathophysiological mechanisms, rather than an indirect slowly evolving weight gain-related metabolic syndrome pathway. Clinicians should be aware of this complication, enabling timely diagnosis and proper treatment.

Download Full-text