Metabolic syndrome incidence is increasing worldwide then it is important to study the possible risk and protective factors. Our previous study suggested an association between coffee consumption and metabolic syndrome. The aim of this study was to address possible associations between dietary lifestyle factors with metabolic syndrome. In a case-control study we compared 74 metabolic syndrome patients with 176-matched controls attended at a public health central unit. Incident cases diagnosed according to ATP III criteria were matched with control group composed of healthy subjects performing routine examinations. Having lower educational level compared to highest levels tend to increase metabolic syndrome prevalence, which was not statistically significant. Similar pattern was observed for marital status. No difference was found regarding gender and metabolic syndrome odds. Interestingly, daily drinking two to three cups of coffee (OR=0.0646, 95% CI, 0.0139-0.3005, p=0.0005) or until 2 cups of milk were inversely associated with metabolic syndrome odds (OR=0.5368, 95% CI, 0.3139-0.9181, p=0.0231). Sleeping seven to eight hours per night was also associated with decreased odds of metabolic syndrome (OR=0.0789, 95% CI, 0.0396-0.1570, p<0.0001). Eating at least two portions of chocolate was also associated with decreased risk of metabolic syndrome (OR=0.3475, 95%CI, 0.1865-0.6414, p=0.0009). Adequate sleeping and dietary intake of some foods materially decreased the metabolic syndrome.
Beyond its effects on cardiovascular and type 2 diabetes mellitus risk, metabolic syndrome pathogenesis involves massive release of pro-inflammatory factors (c-reactive protein, intercellular adhesion molecules, and monocyte chemoattractant protein-1), adipokines (adiponectin and resistin) and cytokines (TNF-a, IL-6) [1]. Excessive production of pro-inflammatory factors can decisively contribute to cancer initiation and promotion [2], which could explain the increased risk of hepatocellular carcinoma, and renal cell carcinoma due to obesity and metabolic syndrome [3,4].
Since prevalence of metabolic syndrome is increasing worldwide [5,6], it is urgent to study the role of nutritional interventions [7], as well as possible risk or protective factors, especially those related to the human lifestyle (diet, sleep, physical activity, fat/weight gain). In this manner, dietary intake of milk and calcium has been associated with lower prevalence and incidence of metabolic syndrome [8,9]. Similar protective effect of regular milk intake (at least one cup per day) regarding reduction of metabolic syndrome risk was observed in data from Korean NHANES III [10].
Shorter sleep duration has also been inversely associated with metabolic syndrome risk [11]. A preliminary study had reported an inverse association between coffee drinking and metabolic syndrome risk [12]. In this respect, the objective of this work was to study metabolic syndrome and its possible associated factors among a Brazilian population.
Materials and Methods
This descriptive and transversal case-control study covered 250 people, from 18 to 81 years old, attending at "Arnulfo da Cunha Coutinho" public laboratory from Barra do Garças, MT, Brazil. The adopted diagnostic criteria for metabolic syndrome case was the revised ATP III [13]. Controls were people who had none of the clinical and laboratory criteria for metabolic syndrome. We compared 74 metabolic syndrome patients with 176-matched controls attended at a public health central unit. Incident cases diagnosed according to ATP III guidelines were matched with control group composed of healthy subjects performing routine examinations. Following the revised National Cholesterol Education Program (NCEP) ATP III guidelines, subjects with three or more of the following criteria were defined as having metabolic syndrome: abdominal obesity (waist circumference > 88 cm in women and > 102 cm in men); hypertriglyceridemia (triglycerides > 150 mg/dL; for conversion to millimoles per liter, multiply by 0.0113); low high-density lipoprotein cholesterol fraction (< 40 mg/dL in men and < 50 mg/dL in women; for conversion to millimoles per liter, multiply by 0.0259); high blood pressure (130/85 mmHg); high fasting glucose levels (100 mg/dL; for conversion to millimoles per liter, multiply by 0.0555) [13].
Blood samples were collected to determinate fasting glycemia, total cholesterol, LDL-cholesterol, HDL, urea, and triglycerides. Body weight and waist circumference were measured using a digital body scale TBF-551 model (Tanita®, Japan) and an anthropometric tape (Sanny, Brazil).
In 2013, the Brazilian minimum salary was R$678.00 which is equivalent to US$297.00 according to the Ministry of Work and Employment (http://portal.mte.gov.br/sal_min/). Before engaging into the research people received an explanation regarding the procedures and they signed a written informed consent. The study was approved by the Ethics Committee on Research of the Julio Müller University Hospital (HUJM), from Federal University of Mato Grosso (UFMT) (protocol. no.668/CEP-HUJM/09).
The estimation of odds ratio and data analysis were performed using the programs epicalc® and epitools®. Considering that the distribution of sample population is approximately normal, a two-tailed 2-sample z test was used to compare sample proportions, considering at least a 5% significance level (p < 0.05).
Results
In the current study, prevalence of metabolic syndrome was higher (29.6%). Other socioeconomic and epidemiological characteristics of studied the population are presented in Table 1.
As expected hyperglycemia and having 40 years old or more had been associated with increased prevalence (or odds) of metabolic syndrome (Table 2). Having lower educational level compared to highest levels trend to increase metabolic syndrome prevalence, which was not statistical significant. Similar pattern was observed for marital status. No difference was found regarding gender and metabolic syndrome odds.
Interestingly, daily drinking two to three cups of coffee (p = 0.0005) or until 2 cups of milk (p = 0.0231) were inversely associated with metabolic syndrome odds. Sleeping seven to eight hours per night was also associated with decreased odds of metabolic syndrome (p = 0.0001) (Table 2).
Discussion
The first national survey regarding metabolic syndrome in Brazil reported a 14.2% of prevalence [14]. However, the prevalence of metabolic syndrome in Central Brazil reached 32% [15]. In the current study which was performed in a Central-Western Brazilian city, the prevalence of metabolic syndrome was similar to previous studies in Brazil [14] and Korea [10].
In a previous study, with a sample of adults from the same city, there was no association between education and metabolic syndrome, whereas lowest family income was correlated with increased odds of that disease [16]. In the present study, regular milk intake was associated with decreased odds of metabolic syndrome. This is in accordance with previous study in France, Korea, and UK [8,9,10]. A meta-analysis also reported that regular dietary intake of high-fat dairy foods was also inversely associated with obesity [17].
According to the systematic review performed by Cappuccio et al. (2010) [18], there is no literature consensus regarding short sleep duration. Some authors consider short sleep as being 5 hours, 6 hours, and 7 hours per night [18]. Anyway, sleep 7 hours or less is very harmful. Many studies have been reported inverse associations between short sleep duration and metabolic syndrome risk [11,19]. In the current study, exposition to seven to eight hours of sleep was associated with decreased risk of metabolic syndrome. This result is in accordance with a previous report [20]. It has been suggested that sleeping 5 hours induced β-cell dysfunction and hyperglycemia as well as it provoked insulin resistance, contributing to obesity pathogenesis [21,22]. Sleeping 5 hours or sleep restriction (some consecutive days of shorter sleep, e.g., 5 hours per night) has also been associated inflammation, impairment of growth hormone secretion, delay on muscle glucose regulation and insulin sensitivity, oxidative stress, and endothelium dysfunction both biological mechanisms involved in cardiometabolic disorders [21,23].
Previous studies have been suggested a protective effect of coffee on metabolic syndrome risk [11,16,24]. The current study also observed an inverse association between coffee drinking and metabolic syndrome. Experimental studies with rats demonstrated that caffeine intake improved glucose tolerance, insulin sensitivity, and decreased liver steatosis, body fat, and systolic blood pressure [25].
In an obesity rat model regular coffee drinking improved both blood glucose values and decreased expression of eight inflammatory genes [26]. Into the same approach, regular intake of coffee up-regulated mitochondrial citric acid cycle and urea cycle [27]. Both studies suggested important plausible biological anti-metabolic syndrome mechanisms.
Comparing people who did not eat chocolate with those who ate at least two portions of chocolate per day a decreased prevalence of metabolic syndrome was found. A systematic review and meta-analyses study suggested that chocolate consumption was associated with reduced risk of cardiometabolic diseases [28]. However, the NHLBI Family Health Study, a transversal epidemiological design, found no association between chocolate intake and metabolic syndrome prevalence [29].
Among obese mice feeding a high-fat diet supplemented with high polyphenolic cocoa it was reported a decrease on body weight gain, insulin resistance, inflammation, and liver steatosis with concomitant increase on fecal lipid excretion [30]. In this regard, daily intake of chocolate had been associated with decreased risk of overall cardiovascular disease (19%), coronary artery disease (23%), incident type 2 diabetes mellitus (28%), and cerebrovascular disease (32%) in humans [31]. The present study with a small sample confirmed the data from previous studies with larger populations [8,9,10,11,12,19,29]. Notwithstanding, the sample size, the use of a food frequency questionnaire, and use a non-probabilistic sampling, were the limitations of the present work.
Conclusion
Normal sleep duration (7-8 hours), milk and chocolate intake, and coffee drinking were inversely associated with metabolic syndrome prevalence. But more epidemiological and experimental studies are needed.
No conflict interests were declared by any of the authors.
BaeYJKimSHChungJHSongSWKimKSKimMKKwonOChoiMSSungMKEvaluation of adiposity-related biomarkers as metabolic syndrome indicators201329199ComstockSSHortosKKovanBMcCaskeySPathakDRFentonJIAdipokines and obesity are associated with colorectal polyps in adult males: a cross-sectional study20149e85939ShimizuMTanakaTMoriwakiHObesity and hepatocellular carcinoma: targeting obesity-related inflammation for chemoprevention of liver carcinogenesis201335191202HäggströmCRappKStocksTManjerJBjørgeTUlmerHEngelandAAlmqvistMConcinHSelmerRLjungbergBTretliSNagelGHallmansGJonssonHStattinPMetabolic factors associated with risk of renal cell carcinoma20138e57475van Vliet-OstaptchoukJVNuotioMLSlagterSNDoironDFischerKFocoLGayeAGögeleMHeierMHiekkalinnaTJoensuuANewbyCPangCPartinenEReischlESchwienbacherCTammesooMLSwertzMABurtonPFerrettiVFortierIGiepmansLHarrisJRHillegeHLHolmenJJulaAKootstra-RosJEKvaløyKHolmenTLMännistöSMetspaluAMidthjellKMurtaghMJPetersAPramstallerPPSaaristoTSalomaaVStolkRPUusitupaMvan der HarstPvan der KlauwMMWaldenbergerMPerolaMWolffenbuttelBHThe prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies2014149GrundySMMetabolic syndrome pandemic200828629636KimJBeaWLeeKHanJKimSKimMNaWSohnCEffect of the telephone-delivered nutrition education on dietary intake and biochemical parameters in subjects with metabolic syndrome20132115124ElwoodPCPickeringJEFehilyAMMilk and dairy consumption, diabetes and the metabolic syndrome: the Caerphilly prospective study200761695698FumeronFLamriAAbi KhalilCJaziriRPorchay-BaldérelliILantieriOVolSBalkauBMarreMData from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR) Study GroupDairy consumption and the incidence of hyperglycemia and the metabolic syndrome: results from a french prospective study, Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR)201134813817KwonHTLeeCMParkJHKoJASeongEJParkMSChoBMilk intake and its association with metabolic syndrome in Korean: analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III)20102514731479WuMCYangYCWuJSWangRHLuFHChangCJShort sleep duration associated with a higher prevalence of metabolic syndrome in an apparently healthy population201255305309TakamiHNakamotoMUemuraHKatsuuraSYamaguchiMHiyoshiMSawachikaFJutaTArisawaKInverse correlation between coffee consumption and prevalence of metabolic syndrome: baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study in Tokushima, Japan2013231220GrundySMCleemanJIDanielsSRDonatoKAEckelRHFranklinBAGordonDJKraussRMSavagePJSmithSCJrSpertusJACostaFAmerican Heart Association; National Heart, Lung, and Blood InstituteDiagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement200511227352752SáeNNMouraECFactors associated with the burden of metabolic syndrome diseases among Brazilian adults20102618531862DutraESde CarvalhoKMMiyazakiEHamannEMItoMKMetabolic syndrome in central Brazil: prevalence and correlates in the adult population2012420FonsecaAGADavidLAFerrariGSFerrariCKPrevalência de síndrome metabólica em pacientes atendidos na estratégia de saúde da família de Barra do Garças, MT201211290295KratzMBaarsTGuyenetSThe relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease201352124CappuccioFPD'EliaLStrazzulloPMillerMASleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies201033585592KobayashiDTakahashiODeshpandeGAShimboTFukuiTRelation between metabolic syndrome and sleep duration in Japan: a large scale cross-sectional study201150103107ChaputJPMcNeilJDesprésJPBouchardCTremblayASeven to eight hours of sleep a night is associated with a lower prevalence of the metabolic syndrome and reduced overall cardiometabolic risk in adults20138e72832ColwellCSMatveyenkoAVTiming is everything: implications for metabolic consequences of sleep restriction20146318261828HjorthMFChaputJPDamsgaardCTDalskovSMAndersenRAstrupAMichaelsenKFTetensIRitzCSjödinALow physical activity level and short sleep duration are associated with an increased cardio-metabolic risk profile: a longitudinal study in 8-11 year old Danish children20149e104677TufikSAndersenMLBittencourtLRMelloMTParadoxical sleep deprivation: neurochemical, hormonal and behavioral alterations. Evidence from 30 years of research200981521538AbrahãoSAPereiraRGde SousaRVLimaARCremaGPBarrosBSInfluence of coffee brew in metabolic syndrome and type 2 diabetes201368184189PanchalSKWongWYKauterKWardLCBrownLCaffeine attenuates metabolic syndrome in diet-induced obese rats20122810551062JiaHAwWEgashiraKTakahashiSAoyamaSSaitoKKishimotoYKatoHCoffee intake mitigated inflammation and obesity-induced insulin resistance in skeletal muscle of high-fat diet-induced obese mice20149389TakahashiSSaitoKJiaHKatoHAn integrated multi-omics study revealed metabolic alterations underlying the effects of coffee consumption20149e91134Buitrago-LopezASandersonJJohnsonLWarnakulaSWoodADi AngelantonioEFrancoOHChocolate consumption and cardiometabolic disorders: systematic review and meta-analysis2011343d4488TokedeOAEllisonCRPankowJSNorthKEHuntSCKrajaATArnettDKDjousséLChocolate consumption and prevalence of metabolic syndrome in the NHLBI Family Heart Study20127e139e143GuYYuSLambertJDDietary cocoa ameliorates obesity-related inflammation in high fat-fed mice201453149158Andra-IuliaSLauraMSuceveanuAIrinelPDoinaCParisSVoineaFThe cardiometabolic benefits of flavonoids and dark chocolate intake in patients at risk2014201418
Socioeconomic and epidemiological characteristics of the population
Variable
n
%
Education
Iliterate
7
2.80
Incomplete elementary
96
38.40
Elementary
71
28.40
Incomplete high-school
15
6.00
High-school
41
16.40
College
20
8.00
Ethnicity
White
169
67.60
Black
15
6.00
Others
63
25.20
Indigenous
3
1.20
Gender
Female
147
57.20
Male
103
42.80
Marital status
Single
69
27.60
Married
126
50.40
Separated/divorced
15
6.00
Widowed
28
11.20
Alcohol drinking
No
198
79.20
Some days
52
20.80
Smoking
No
166
66.40
Yes
84
33.60
Diabetes mellitus
No
107
42.80
Yes
23
9.20
Don't know
120
48.00
High blood cholesterol
No
90
36.00
Yes
73
29.20
Don't know
87
34.80
Hypertension
No
38
15.20
Yes
190
76.00
Don't know
22
8.80
Metabolic syndrome
No
176
70.40
Yes
74
29.60
Metabolic syndrome by gender
Female
47
32.87
Male
27
25.23
Odds risk values and significance level of variables in metabolic syndrome
Variable
Odds ratio
95% confince interval
Significance level
Age
18-19
0.0002
0.0000 - 0.0116
p < 0.0001
20-39
1.2486
0.7132 - 2.1860
p = 0.4371
40 and +
2.6919
1.5597 - 4.6457
p = 0.0004
Education*
Elementary x high school/college
1.6889
0.9550 - 2.9853
p = 0.0714
Family income
(≤ 1 salary† x > 1salary)
1.8065
1.0004 - 3.2619
p = 0.0498
Gender‡
Women x men
0.9700
0.5876 - 1.6200
p = 0.9200
Marital status§
Married x single
1.6789
0.9114 - 3.0929
p = 0.0964
Divorced/separated x widow
0.7917
0.2410 - 2.6000
p = 0.7002
Hyperglicemia
Hyperglycemia x normoglycemia
2.1957
1.2521- 3.8500
p = 0.0061
Chocolate∥
Don't eat x eat (2 to 5 portions per day)
0.3475
0.1865 - 0.6474
p = 0.0009
Coffee¶
Don't drink x 2-3 cups/day
0.0646
0.0139 - 0.3005
p = 0.0005
Milk**
Don't drink x ≤ 2 cups per day
0.5368
0.3139 - 0.9181
p = 0.0231
Sleep††
< 7 hours x 7-8 hours
0.0789
0.0396 - 0.1570
p < 0.0001
*Elementary education compared to those with high school and/or college degree; †The official value of minimum salary was US$297.00; ‡Women compared to the men; §Married compared to the single. Divorced or separated compared to the widow; ∥Do not eat compared to eat 2 to 5 portions/day; ¶Do not drink compared to drink 2 or 3 cups/day; **Do not drink compared to drink 1 or 2 cups per day; ††Sleep < 7 hours per night compared to those who sleep 7 to 8 hours/night.