Harfeel, Sondos Abd-Erraheem Jameel
(2022)
Metabolic syndrome and level of
lipopolysaccharide binding protein:
proportionate, associated factors and
the effectiveness study of probiotics
supplementation among population in
Sharjah, UAE.
PhD thesis, Universiti Sains Malaysia.
Abstract
Metabolic Syndrome (MetS) is a cluster of risk factors associated with heart
diseases, diabetes, and stroke that is rapidly growing in modern societies. The MetS
prevalence, accompanied by alterations in gut microbiota, leads to low-grade
inflammation and metabolic endotoxemia. The impact of the probiotic intervention on
restoring the normal constituents of the gut microbiota, reducing inflammation and
endotoxemia, was hypothesized. This study aimed to investigate the prevalence of
MetS, the associated factors with Lipopolysaccharides Binding Protein (LBP), the
homeostasis model of insulin resistance (HOMA-IR), and to study the effect of
probiotics supplementation on the MetS associated factors, inflammatory markers, and
endotoxemia among the population in Sharjah, United Arab Emirates (UAE). This
study was conducted in Sharjah from 2016 until 2019 in two phases (Phase-1 and
Phase-2). For the Phase- I cross-sectional study, 272 adults (107 males and 165
females) from the Sharjah community were recruited. Anthropometric measurements,
body composition analysis (BCA), and biochemical assays (fasting glucose, lipid
profile, insulin, hs-CRP, IL-6, TNF-, and LBP) were performed. Food frequency and
sociodemographic data were analyzed. The phase-2 intervention study was conducted
as a randomized parallel double-blinded placebo-controlled trial. Eighty-two adults (23
males and 59 females) were enrolled. The participants were allocated to two groups;
43 in the intervention and 39 in the control placebo group. Anthropometric, BCA,
and biochemical parameters were assessed at baseline and following eight weeks of consecutive consumption of Lyophilized tablets of blended Lactobacillus containing
(L. acidophilus, L. casei, and L. rhamnosus) for the intervention group or maltodextrincontaining
tablets for the control group. The mean age of the participants in phase 1
was 35.1(10.8) years old, and 25% were diagnosed with MetS. The participants with
MetS had significantly higher HOMA-IR [4.06(3.38) vs 2.23(1.65); p<0.001]. LDL-C
and FBG were significant risk factors of Mets [OR=1.02; 95%CI = (1.00 – 1.03), and
OR=1.12; 95%CI= (1.06 – 1.17), respectively]. None of the inflammatory markers had
a significant effect on MetS. Males were 3.08 times higher than females to develop
MetS (adjusted OR=30.8; 95%CI = (1.65 – 5.75)]. The age groups (40 < and ≥ 40
years) and food intake were not significantly different between participants with and
without MetS. HOMA-IR affected MetS diagnosis [adjusted OR=1.62; 95%CI = (1.35-
1.93)]. As HOMA-IR increases by one unit (mmol\L), the change to develop MetS
increases by 62%. The receiver operating characteristic (ROC) curve of HOMA-IR was
used to diagnose MetS, and the corresponding cutoff point for HOMA-IR was ≥ 3.215.
There was no significant difference in the LBP levels with the HOMA-IR, age groups
or any of the MetS components or anthropometric measurements between those with
and without MetS. TNF-α and hs-CRP had an effect on LBP concentration [p=0.001].
There was a significant weight reduction in the intervention group than in the control
group. The change was more in the intervention group in the body mass index (BMI)
[-0.18(0.8) vs 0.24(0.57); p-value=0.009], waist circumference (WC) [-2.4(3.47 vs -
0.24(3.05); p-value=0.011], systolic BP [- 7.86(11.6) vs 3.33(16.32); p-value=0.001],
diastolic BP [-3.4(6.53) vs 1.13(6.97); p-value=0.003], fat mass [-0.63(2.6) vs
1.43(5.36); p-value=0.028], visceral fat rating [- 0.23(0.92) vs 0.21(0.66); p-value
=0.015], and degree of obesity by [-0.75(3.74) vs 0.93(2.52); p-value =0.022]. There
was no significant difference in the mean change in all biochemical parameters
between the two groups. In conclusion, the prevalence of MetS was 25% of the population and was higher in males. HOMA-IR could have a greater significant effect
on the development of low-grade inflammation than LBP. The level of LBP was not
associated with MetS components. The HOMA-IR cutoff value estimated in this study
should be further investigated in large-scale studies in the UAE population. Probiotics
induced a substantially reduced BMI, WC, fat mass, visceral fat rating, and obesity.
There were no significant changes in the biochemical parameters or other MetS
components. Further intervention studies on the effect of probiotics on the gut
microbiota and their impact on the MetS, inflammation and endotoxemia are essential
in the UAE population.
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