1

Relation between dietary macronutrient and

fiber intake with metabolic syndrome in

Tehranian adults:

Tehran Lipid and Glucose Study

Hosseinpour S, Mirmiran P, hosseinpanah F, Azizi F

Obesity research center, Research Institute for Endocrine Science, Sahid Beheshti University of Medical Sciences

introductionAdult treatment panel (ATP) III guidelines

High serum triglyceride levels (TG≥150 mg/dl) Low HDL-C (<40 mg/dl for men and <50 mg/dl for women) Elevated blood pressure ( ≥130 and/or ≥85 mm Hg) Abnormal glucose hemeostasis (FBG ≥100 mg/dl) Abdominal obesity

American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

Criteria of abdominal obesity were specified by nationality or ethnicity on best available population estimate

*In men ≥89 cm In women ≥91 cmGrundy et al. Circulation 2005; 112Delavari et al. Diabetes care 2009; 32: 1092

introduction(con`s)

MetS Increased risk of developing:

Diabetes Cardiovascular Disease Chronic kidney Diesease Cancer (breast, colorectal) Stroke and cerebrovasculare disease(in Asia)

Prevalence of MetS In representative sample in Tehran 42% in women 24% in men In nationwide study in 30 province 35.6%Three years follow-up 2%

Metabolic syndrome is growing into a significant public health problemAzizi et al. Diabetes Res Clin Pract 2003; 61

Delavari et al. Diabetes Care 2009; 32

introduction(con`s)

Attributable factor

genetic

• APOBrs12535• LTA rs915654• ACACB rs4766587

Environmental

and behavior

•diet•Physical activity•Smoking

Metabolic

syndrome

Feldeisen et al. Appl Physiol Nutr Metab 2007; 32Galisteo et al. J Nutr Biochem 2008; 19

objective

Examines the cross-sectional associations between macronutrients and fiber intake

With metabolic syndrome in Tehranian adults.

Materials and methods study design and sample

Representative sample of district 13 of Tehran ,Tehran lipid and glucose study , third examination : 15 005

Participants with complete FFQ data : 3 568

Final population for analysis(n=1435)

Materials and methods(cont’)

Assessment of criteria

Dietary intakeFFQ (valid and reliable)

Anthropometric Weight, Height, Waist, Hip, BMI, WHR

Biochemical assessmentFBGTGHDL-C

Medical history

Materials and methods(cont’)

Statistical analysisCharacteristic of participants were compared by sex using t test, and chi-square.

logestic regression was used to study associations among quartile of macronutrient and fiber intakes with MetS, adjusted for age, smoking, energy intake and druge use, BMI and WHR. Odds Ratio of developing MetS were evaluate across quartile of macronutrients and fiber.

results

Baseline characteristics of the subject by sex.

variable Male(n=632)

Female(803)

Age (y) 36.8 ± 10.6 35.2 ± 10.9Weight (kg) 74.6 ± 13.8 66.8 ± 12.9*

BMI (kg/m2) 26.8 ± 4.5 25.7 ± 5.2Waist girth (cm) 93.5 ± 10.8 83.5 ± 13.4*

WHR 0.93 ± 0.06 0.81 ± 0.08*

Triglycerides (mg/dl) 150 ± 94.9 124 ± 81*HDL-C (mg/dl) 39.3 ± 9.4 46.1 ± 10.3*

Systolic blood pressure (mm Hg) 113.3 ± 13.4 105.5 ± 14.4Diastolic blood pressure (mm Hg) 74.5± 10.6 70.5 ± 10.3Fasting blood sugar (mg/dl) 90.4 ± 21.4 89.1 ± 22.8Physical activity (MET_hr/Week) 40.7± 61.8 32.3 ± 41.0*Current Estrol druge use (%) 1.8% 6%Metabolic syndrome (%) 38.2 31.2*Smoking status(%) Non smoker Current smoker Ex-smoker

6421.514.5

943.52.5

* Significantly different from male, P<0.05

Macronutrient and fiber intake in male and female participants.

nutrientsMale Female

Energy (kcal/d) 2636±696 2283±522*

Carbohydrate

g/d 387.3±199.8 321±158* % of energy 58.6±7.2 56.4±7.5Total fat

g/d 88.3±44.0 83.6±45.0* % of energy 30.1±6.8 32.6±7.3protein

g/d 89.63±45.2 77.1±37.4*

% of energy 13.6±2.5 13.6±2.6fiber

Total fiber (g/d) 44.5±32.1 36.3±24.0*Soluble fiber (g/d) 0.6±1.14 0.5±0.4Insoluble fiber (g/d) 3.2±8.9 2.8±5.6

*Significantly different from male, P<0.05. § P=0.07

Baseline characteristics of the third TLGS participant by sexMale(MetS) Female(MetS)

variable Yes No Yes No Age (y) 45.2±14.8 32.9±17.2* 49.6±11.9 31.7±14.2* Weight (kg) 85.1±13.1 69.4±18.3* 76.4±11.9 61.8±14.0* BMI (kg/m2) 28.9±3.7 24.1±±4.7* 31.5±4.4 24.9±5.2* Waist girth (cm) 101±8.4 86.4±13.7* 98.5±9.1 78.9±13.0* WHR 0.9±0.04 0.9±0.07 0.9±0.06 0.7±0.07* hypertriglyceridemia (%) 84.2 15.2* 83.3 12.3* Low HDL-C (%) 92.1 44.4* 92.1 62.3* High Systolic blood pressure (%) 34.9 5.8* 37.2 3.1* High Diastolic blood pressure (%) 34.5 6.6* 29.0 2.6* Hyperglycemia (%) 17.9 1.1* 31.5 1.3* Physical activity (MET_hr/Week)

37.48±61.0 42.7±7.9* 34.0±39.3 30.5±44.3

Current estrol druge use (%) 1.2 2.3 2.5 3.7

Smoking status(%)Non smokerCurrent smokerEx-smoker

6720.512.5

5726.516.5

921.26.8

952.22.8

*significantly different from metabolic syndrome, P<0.05

Macronutrient and fiber intake by metabolic syndrome in male and female participants.

Male(MetS) Female(MetS)

nutrients Yes No Yes NoEnergy (kcal/d) 2753±607 2553±578 2157±628 2300±606Carbohydrate g/d 386.4±88.3 340±83.1* 324±93 293±91*

% of energy 66.5±6.9 57.8±6.9* 58.5±6.9 50.1±7.0*

Total fat g/d 85.1±29.3 89.2±26.1 81.2±33.1 84.7±29.1 % of energy 30.1±6.8 30.8±6.7 30.1±6.8 33.9±6.9protein g/d 87.1±29.3 91.2±26.1 76.2±23.6 79.2±23.8

% of energy 13.5±2.1 13.6±2.3 13.6±2.1 13.5±2.1

Total fiber (g/d) 43.1±19.6 46.2±19.8 28.6±19.937.5±15.5§

Soluble fiber (g/d) 0.5±1.3 0.7±1.2 .5±0.5 .5±0.4Insoluble fiber (g/d) 2.3±1.5 3.9±8.7 2.7±1.7 2.9±1.8

*Significantly different from male, P<0.05. § P=0.07

Odds ratio and 95% confidence interval (CI) of having metabolic syndrome, by quartile of macronutrient intake based on data from third TLGS .

male female

nutrient 12 3 4 P-

value1

2 3 4P -

value

Carbohydrate (g/d)

Model I 1 1.9(0.7-2.3) 2.0(0.7-2.4) 1.9(1.0-1.7) 0.27 1 1.9(0.6-2.2) 1.9(0.7-2.3) 1.8(0.7-2.1) 0.75

Model II 1 1.8(0.7-2.4) 1.7(0.6-2.1) 1.8(0.8-2.1) 0.40 1 1.8(0.4-2.2) 1.7(0.6-1.9) 1.8(0.4-1.9) 0.23

Model III 1 1.7(0.6-1..9) 1.9(0.5-2.2) 1.7(0.7-2.1) 0.78 1 1.8(0.5-2.6) 1.0(0.6-2.9) 1.7(0.4-2.4) 0.40

Carbohydrate (% of energy)

Model I 1 1.6(1.4-2.8) 1.7(1.5-2.9) 1.8(1.6-1.9) 0.07 1 1.6(1.4-1.8) 1.6(1.4-1.7) 1.7(1.5-1.8) 0.01

Model II 1 1.4(0.6-1.7) 1.9(1.6-2.4) 1.7(0.7-2.3) 0.79 1 1.0(0.7-1.4) 1.5(0.5-1.8) 1.7(0.4-1.9) 0.30

Model III 1 1.2(0.7-1.4) 1.1(0.6-1.9) 1.2(0.7-1.6) 0.80 1 1.0(0.7-1.5) 1.2(0.5-1.5) 1.7(0.5-2.1) 0.35

Model I: crude modelModel II: BMI, WHRModel III: Model II + :adjusted for age, physical activity, total energy intake, smoking, drug use

Odds ratio and 95% confidence interval (CI) of having metabolic syndrome, by quartile of fiber, soluble and insoluble intake based on data from third TLGS .

men women

nutrient 12 3 4 P-

value

12 3 4 P -

value

Total fiber

Model I 1 1.0(0.8-1.4) 0.6(0.5-0.9) 0.8(0.6-1.0) 0.01 1 0.7(0.5-0.9) 0.7(0.5-0.9) 1.0(0.7-1.4) 0.75

Model II 1 0.9(0.7-1.4) 0.7(0.5-1.0) 0.8(0.5-1.2) 0.16 1 0.7(0.4-1.0) 0.7(0.4-1.1) 0.8(0.4-1.6) 0.23

Model III 1 0.8(0.7-1.5) 0.7(0.5-1.0) 0.8(0.6-1.3) 0.27 1 0.6(0.4-1.1) 0.6(0.5-1.3) 0.5(0.4-2.4) 0.40

Model I: crude modelModel II: BMI, WHRModel III: Model II + :adjusted for age, physical activity, total energy intake, smoking, drug use

conclusion

In Tehranian population, macronutrients and fiber intake is not associated with metabolic syndrome.

Tank you for Your attention