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Summary

Recently, Sinatora et al. [1] reported the results of a study aimed at investigating the relationship between inflammatory biomarkers and the metabolic syndrome (MS) in postmenopausal women (n=52, aged 50 to 79 years), in addition to performing cutoff points for IL-10, IL-6, and TNF-α in the diagnosis of MS. This was a cross-sectional observational study based on STROBE in which data were collected from obese (body fat percentage [% BF] ≥ 35%) postmenopausal women (at least 5 years), not on hormone therapy, and taking into consideration different diagnostic criteria for the MS (International Diabetes Federation (IDF); National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III), and Harmonized criteria), comorbidities, and values of interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor- α (TNF-α), fasting glycemia (FG), triglycerides (TG), total cholesterol (TC), very low-density lipoproteins (VLDL-C), low-density lipoprotein (LDL-C), and high-density lipoprotein (HDL-C). Other analyzed parameters included body mass index (BMI), waist circumference (WC), and body composition as determined with bioelectrical impedance analysis. The authors found no significant difference between the methods and no interaction between the method and the presence of MS. However, for the values of WC, BF%, TNF-α, and IL-10/TNF-α ratio, a significant effect of the MS was observed. Those with the MS displayed lower values of BF% and TNF-α and higher values of the IL-10/TNF-α ratio. The higher IL-10/TNF-α ratio in the MS group was related to the greater anti-inflationary action of IL-10 and the IL-10/TNF-α ratio showed significant accuracy to discriminate women with MS according to the NCEP-ATP III criteria. The authors conclude that BF% and the lower TNF-α values in the groups with MS highlight the relationship between these variables. Higher IL-10/TNF-α ratio values in the MS group suggest that higher IL-10 concentrations may be contributing to the reduction of TNF-α in the MS group. Furthermore, the IL-10/TNF-α ratio showed significant accuracy to discriminate patients with MS according to the NCEP criteria.

Commentary

The MS is a multifactorial metabolic condition that is currently considered worldwide an important public health problem in women and men, with rates that vary from 20 to 25% depending on the studied population [2]. After the menopause and with age there is an increase in the prevalence of the MS and the deposition of visceral fat that increases the production of pro-inflammatory cytokines (i.e TNF-α, IL-6), and a decrease in anti-inflammatory cytokines (i.e IL-10). This chronic pro-inflammatory status increases cardiovascular risk in women. Some, pro-inflammatory cytokines such as TNF-α, seem to aggravate hypertension associated with hyperglycemia, visceral obesity, and dyslipidemia. Indeed, one study performed among postmenopausal women found TNF-α levels positively correlating with age, time since menopause and blood pressure levels [3]. Prevalence of the MS may also be influenced by the criteria used to define the MS. In this sense we have those set by the IDF, NCEP, WHO, and recently the harmonized one. Indeed, in the presently commented study of Sinatora et al. [1], lower rates of the MS were found using NCEP criteria as compared to harmonized and the IDF criteria. It is important to highlight that the main purpose of these criteria is to identify women with the syndrome and from a preventive perspective is that they receive timely and appropriate intervention, the more the better, thus decrease not only cardiovascular risk yet others such as cancer, death, depression, sleep disorders.

There are cost-effective ways to perform intervention in postmenopausal women with the MS, ranging from drugs, dieting and the increase of physical activity; that should not begin in the postmenopause yet in the premenopausal stage when diagnosis is performed [4]. Despite the advances in medicine, the MS and cardiovascular diseases are still high. The combination of a diet rich in antioxidants and anti-inflammatory compounds has a critical role in reducing oxidative stress and pro-inflammatory processes that are closely associated with endothelial dysfunction and the development of atherosclerotic plaques. The Mediterranean diet, for example, presents at least six classes of phenolic components with powerful antioxidant properties [5].

In conclusion, timely diagnosis of the MS and appropriate intervention/prevention are key at reducing related risks. These interventions should be performed once the diagnosis of the MS is made.

Peter Chedraui, MD, PhD
Instituto de Investigación e Innovación en Salud Integral
Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador

References

  1. Sinatora RV, Chagas EFB, Mattera FOP, et al. Relationship of Inflammatory Markers and Metabolic Syndrome in Postmenopausal Women. 2022;12(1):73.
    https://pubmed.ncbi.nlm.nih.gov/35050195/
  2. Hidalgo LA, Chedraui PA, Morocho N, Alvarado M, Chavez D, Huc A. The metabolic syndrome among postmenopausal women in Ecuador. Gynecol Endocrinol. 2006;22(8):447-54.
    https://pubmed.ncbi.nlm.nih.gov/17012107/
  3. Chedraui P, Jaramillo W, Pérez-López FR, Escobar GS, Morocho N, Hidalgo L. Pro-inflammatory cytokine levels in postmenopausal women with the metabolic syndrome. Gynecol Endocrinol. 2011;27(9):685-91.
    https://pubmed.ncbi.nlm.nih.gov/20937002/
  4. Barriga J, Castelo-Branco C, Chedraui P, Hidalgo L, Veas P. Educational and organizational interventions used to improve the knowledge of metabolic syndrome among postmenopausal women. Fertil Steril. 2008;90(2):444-6.
    https://pubmed.ncbi.nlm.nih.gov/17980869/
  5. Alkhatib DH, Jaleel A, Tariq MNM, et al. The Role of Bioactive Compounds from Dietary Spices in the Management of Metabolic Syndrome: An Overview. 2021;14(1):175.
    https://pubmed.ncbi.nlm.nih.gov/35011050/

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If you would like to add a comment or contribute to a discussion based on this issue, please contact Menopause Live Editor, Peter Chedraui, at peter.chedraui@cu.ucsg.edu.ec.

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