Digital Commons Network^™

The Impact Of Meal Dietary Inflammatory Index On Exercise-Induced Changes In Airway Inflammation In Adults With Asthma, Katrina P. Mcdiarmid, Lisa G. Wood, John W. Upham, Lesley K. Macdonald-Wicks, Nitin Shivappa Mbbs, Mph, Ph.D., James R. Hébert Scd, Hayley A. Scott

Faculty Publications

Research suggests exercise may reduce eosinophilic airway inflammation in adults with asthma. The Dietary Inflammatory Index (DII®) quantifies the inflammatory potential of the diet and has been associated with asthma outcomes. This study aimed to determine whether the DII of a meal consumed either before or after exercise influences exercise-induced changes in airway inflammation. A total of 56 adults with asthma were randomised to (1) 30–45 min moderate–vigorous exercise, or (2) a control group. Participants consumed self-selected meals, two hours pre- and two hours post-intervention. Energy-adjusted DII (E-DIITM) was determined for each meal, with meals then characterised as “anti-inflammatory” or …

Genome-Wide Association Analyses Of Physical Activity And Sedentary Behavior Provide Insights Into Underlying Mechanisms And Roles In Disease Prevention, Zhe Wang, Andrew Emmerich, Nicolas J. Pillon, Tim Moore, Daiane Hemerich, Marilyn C. Cornelis, Eugenia Mazzaferro, Siacia Broos, Tarunveer S. Ahluwalia, Traci M. Bartz, Amy R. Bentley, Lawrence F. Bielak, Mike Chong, Audrey Y. Chu, Diane Berry, Rajkumar Dorajoo, Nicole D. Dueker, Elisa Kasbohm, Bjarke Feenstra, Mary F. Feitosa, Mark A. Sarzynski Ph.D., Faha, Facsm, Et. Al.

Faculty Publications

Although physical activity and sedentary behavior are moderately heritable, little is known about the mechanisms that influence these traits. Combining data for up to 703,901 individuals from 51 studies in a multi-ancestry meta-analysis of genome-wide association studies yields 99 loci that associate with self-reported moderate-to-vigorous intensity physical activity during leisure time (MVPA), leisure screen time (LST) and/or sedentary behavior at work. Loci associated with LST are enriched for genes whose expression in skeletal muscle is altered by resistance training. A missense variant in ACTN3 makes the alpha-actinin-3 filaments more flexible, resulting in lower maximal force in isolated type IIA muscle …

An Acute Naproxen Dose Does Not Affect Core Temperature Or Interleukin-6 During Cycling In A Hot Environment, Dawn M. Emerson, Stephen Cl Chen, Toni M. Torres-Mcgehee, Craig E. Pfeifer, Charles C. Emerson, J Mark Davis

Faculty Publications

Non-steroidal anti-inflammatory drugs' anti-pyretic and anti-inflammatory effects has led some individuals to theorize these medications may blunt core body temperature (Tc) increases during exercise. We utilized a double-blind, randomized, and counterbalanced cross-over design to examine the effects of a 24-h naproxen dose (3-220 mg naproxen pills) and placebo (0 mg naproxen) on Tc and plasma interleukin-6 (IL-6) concentrations during cycling in a hot or ambient environment. Participants ( = 11; 6 male, 5 female; age = 27.8 ± 6.5 years, weight = 79.1 ± 17.9 kg, height = 177 ± 9.5 cm) completed 4 conditions: 1) placebo and ambient (Control); …

Personal Activity Intelligence And Mortality - Data From The Aerobics Center Longitudinal Study, Javaid Nauman, Xuemei Sui, Carl J. Lavie, Chi Pang Wen, Jari A. Laukkanen, Steven N. Blair, Patrick Dunn, Ross Arena, Ulrik Wisloff

Faculty Publications

Importance Personal activity intelligence (PAI) is a novel activity metric that can be integrated into self-assessment heart rate devices, and translates heart rate variations during exercise into a weekly score. Previous studies relating to PAI have been conducted in the same populations from Norway where the PAI metric has been derived, limiting generalizability of the results.

Objective: To test whether PAI is associated with total and cause-specific mortality in a large cohort from the United States.

Design: Aerobics Center Longitudinal Study (ACLS) – a prospective cohort between January 1974 and December 2002 with a mean follow-up of 14.5 years.

Setting: …

Integrating Survivors Of Stroke Into Exercise‐Based Cardiac Rehabilitation Improves Endurance And Functional Strength, Elizabeth Wherley Regan Dpt, Ph.D., Reed Handlery, Jill Campbell Stewart, Joseph Lee Pearson Ms,Drph, Sarah Wilcox Phd, Stacy L. Fritz Phd, Pt

Faculty Publications

Background

Cardiac rehabilitation (CR) is a structured exercise program prevalent in the United States for people with cardiovascular disease that has been shown to increase cardiovascular endurance and improve quality of life. Despite similar cardiovascular risk factors, stroke is not among the covered diagnoses for CR. The purpose of this study was to examine the participant impact of integrating survivors of stroke into the exercise portion of an existing hospital‐based CR program through measures of physical function and other health impacts and through qualitative evaluation of participant perception.

Methods and Results

Subacute and chronic survivors of stroke were integrated into …

Nutrient Timing: A Garage Door Of Opportunity?, Shawn M. Arent, Harry P. Cintineo, Bridget A. Mcfadden, Alexa Jenny Chandler, Michelle Angelique Arent

Faculty Publications

Nutrient timing involves manipulation of nutrient consumption at specific times in and around exercise bouts in an effort to improve performance, recovery, and adaptation. Its historical perspective centered on ingestion during exercise and grew to include pre- and post-training periods. As research continued, translational focus remained primarily on the impact and outcomes related to nutrient consumption during one specific time period to the exclusion of all others. Additionally, there seemed to be increasing emphasis on outcomes related to hypertrophy and strength at the expense of other potentially more impactful performance measures. As consumption of nutrients does not occur at only …

Linking Activity, Nutrition, And Child Health (Launch): Protocol For A Longitudinal Cohort Study Of Children As They Develop From Infancy To Preschool Age, Russell R. Pate, Edward A. Frongillo Jr., Kerry Cordan, Marsha Dowda, Alexander C. Mclain, Myriam E. Torres, William H. Brown, Agnes Bucko, Emily R. Shull

Faculty Publications

Background

Physical activity is known to provide important health benefits in children ages 3 years and above, but little is known about the effects of physical activity on health in very young children under age 3. LAUNCH (Linking Activity, Nutrition, and Child Health) is a study designed to expand the body of knowledge on development of physical activity behavior and associations between physical activity and other health characteristics as children transition from infancy to preschool age.

Methods

Physical activity and sedentary behavior will be measured objectively in young children over a period of 30 months. Each child will complete a …

Association Of Multisetting Community Programs And Policies With Child Body Mass Index: The Healthy Communities Study, Vicki L. Collie-Akers, Stephen B. Fawcett, Jerry A. Schultz, Kandace K. Fleming, Rebecca E. Swinburne Romine, Lorrene D. Ritchie, Edward A. Frongillo Jr., S Sonia Arteaga

Faculty Publications

INTRODUCTION:

Expert opinion suggests that efforts to address childhood obesity should seek to transform the environments in which children operate. The objective of this study was to describe the extent to which multisetting programs and policies interact with community and child predictors and are associated with child body mass index (BMI) in the 130 US communities participating in the Healthy Communities Study.

METHODS:

For 2 years beginning in fall 2013, we collected data through key informant interviews on community programs and policies related to healthy weight among children that occurred in the 10 years before the interview. We characterized community …

International Society Of Sports Nutrition Position Stand: Nutrient Timing, Chad M. Kerksick, Shawn M. Arent, Brad J. Schoenfeld, Jeffrey R. Stout, Bill Campbell, Colin D. Wilborn, Lem Taylor, Doug Kalman, Abbie E. Smith-Ryan, Richard B. Kreider, Darryn Willoughby, Paul J. Arciero, Trisha A. Vandusseldorp, Michael J. Ormsbee, Robert Wildman, Mike Greenwood, Tim N. Ziegenfuss, Alan A. Aragon

Faculty Publications

Position statement

The International Society of Sports Nutrition (ISSN) provides an objective and critical review regarding the timing of macronutrients in reference to healthy, exercising adults and in particular highly trained individuals on exercise performance and body composition. The following points summarize the position of the ISSN.

1. Nutrient timing incorporates the use of methodical planning and eating of whole foods, fortified foods and dietary supplements. The timing of energy intake and the ratio of certain ingested macronutrients may enhance recovery and tissue repair, augment muscle protein synthesis (MPS), and improve mood states following high-volume or intense exercise.
2. Endogenous glycogen stores …

A Technology-Mediated Behavioral Weight Gain Prevention Intervention For College Students: Controlled, Quasi-Experimental Study, Delia Smith West, Courtney M. Monroe, Gabrielle Turner-Mcgrievy, Beth Sundstrom, Chelsea Larsen, Karen Magradey, Sara Wilcox, Heather M. Brandt

Faculty Publications

BACKGROUND: Both men and women are vulnerable to weight gain during the college years, and this phenomenon is linked to an increased risk of several chronic diseases and mortality. Technology represents an attractive medium for the delivery of weight control interventions focused on college students, given its reach and appeal among this population. However, few technology-mediated weight gain prevention interventions have been evaluated for college students. OBJECTIVE: This study examined a new technology-based, social media-facilitated weight gain prevention intervention for college students. METHODS: Undergraduates (n =58) in two sections of a public university course were allocated to either a behavioral …

Effects Of Exercise On Bmi Z-Score In Overweight And Obese Children And Adolescents: A Systematic Review With Meta-Analysis, George A. Kelley, Kristi S. Kelley, Russell R. Pate

Faculty Publications

Background: Overweight and obesity are major public health problems in children and adolescents. The purpose of this study was to conduct a systematic review with meta-analysis to determine the effects of exercise (aerobic, strength or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.

Methods: Studies were included if they were randomized controlled exercise intervention trials ≥ 4 weeks in overweight and obese children and adolescents 2 to 18 years of age, published in any language between 1990–2012 and in which data were available for BMI z-score. Studies were retrieved by searching eleven electronic databases, …

Cardiorespiratory Fitness Reduces The Risk Of Incident Hypertension Associated With A Parental History Of Hypertension, Robin P. Shook, Duck-Chul Lee, Xuemei Sui, Vivek Prasad, Steven P. Hooker, Timothy S. Church, Steven N. Blair

Faculty Publications

Family history of hypertension increases the risk of an individual to develop hypertension, whereas moderate-to-high cardiorespiratory fitness has the opposite effect. However, the joint association of each on the development of hypertension is not well understood. We studied fitness and incident hypertension in 6278 participants who were given a preventative medical examination. Thirty-three percent reported a parent with hypertension, and there were 1545 cases of incident hypertension after a mean of 4.7 years. The presence of parental hypertension was associated with a 28% higher risk of developing hypertension after adjustments for age, sex, and examination year. After further adjustments for …

Heart Rate Variability And Exercise In Aging Women, Conrad P. Earnest, Steven N. Blair, Timothy S. Church

Faculty Publications

Background: Our group has shown a positive dose-response in maximal cardiorespiratory exercise capacity (VO_2max) and heart rate variability (HRV) to 6 months of exercise training but no improvement in VO_2max for women ≥60 years. Here, we examine the HRV response to exercise training in postmenopausal women younger and older than 60 years.

Methods: We examined 365 sedentary, overweight, hypertensive, postmenopausal women randomly assigned to sedentary control or exercise groups exercising at 50% (4 kcal/kg/week, [KKW]), 100% (8 KKW) and 150% (12 KKW) of the National Institute of Health (NIH) Consensus Development Panel physical activity guidelines. Primary outcomes …

Associations Between Physical Activity And Submaximal Cardiorespiratory And Pulmonary Responses In Men, John C. Sieverdes, Xuemei Sui, Steven N. Blair

Faculty Publications

Background: Habitual physical activity (PA) is associated with higher cardiorespiratory fitness values, but additional information is needed on the contributions of specific types and amounts of PA. Therefore the main aim of this study was to analyze the heart and lung function of a large cohort of men and compare these outcomes with various modes and volumes of PA.

Methods: We used data from 30,594 men from the Aerobics Center Longitudinal Study who were categorized into sedentary, swimmer, walker, and runner groups using self-report PA data collected during 1970-2005. Additional PA categories using MET-minutes/week were used to group men into …

A Randomized Trial Of A Diet And Exercise Intervention For Overweight And Obese Women From Economically Disadvantaged Neighborhoods: Sisters Taking Action For Real Success (Stars), Sarah Wilcox, Patricia A. Sharpe, Deborah Parra-Medina, Michelle L. Granner, Brent E. Hutto

Faculty Publications

Background - Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight loss studies target this population.

Objectives - STARS tests a culturally-appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods.

Design - A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes.

Methods - Participants 25-50 years who had a BMI ≥ 25 kg/m² and a waist circumference ≥ …

Adipose Tissue Endocannabinoid System Gene Expression: Depot Differences And Effects Of Diet And Exercise, Tongjian You, Beth L. Disanzo, Xuewen Wang, Rongze Yang, Dawei Gong

Faculty Publications

Background: Alterations of endocannabinoid system in adipose tissue play an important role in lipid regulation and metabolic dysfunction associated with obesity. The purpose of this study was to determine whether gene expression levels of cannabinoid type 1 receptor (CB1) and fatty acid amide hydrolase (FAAH) are different in subcutaneous abdominal and gluteal adipose tissue, and whether hypocaloric diet and aerobic exercise influence subcutaneous adipose tissue CB1 and FAAH gene expression in obese women.

Methods: Thirty overweight or obese, middle-aged women (BMI = 34.3 ± 0.8 kg/m², age = 59 ± 1 years) underwent one of three 20-week weight …

Prescribing Exercise In Primary Care: Ten Practical Steps On How To Do It, Karim M. Khan, Richard Weller, Steven N. Blair

Faculty Publications

No abstract provided.

Stimulant Reduction Intervention Using Dosed Exercise (Stride) - Ctn 0037: Study Protocol For A Randomized Controlled Trial, Madhukar H. Trivedi, Tracy L. Greer, Bruce D. Grannemann, Timothy S. Church, Eugene Somoza, Steven N. Blair, Jose Szapocznik, Mark Stoutenberg, Chad Rethorst, Diane Warden, Kolette M. Ring, Robrina Walker, David W. Morris, Andrzej S. Kosinski, Tiffany Kyle, Bess H. Marcus, Becca Crowell, Neal Oden, Edward Nunes

Faculty Publications

Background: There is a need for novel approaches to the treatment of stimulant abuse and dependence. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight gain, quality of life, and anhedonia, since it has been shown to improve many of these …

Adherence To Accelerometer Protocols Among Women From Economically Disadvantaged Neighborhoods, Patricia A. Sharpe, Sarah Wilcox, Laura J. Rooney, Donna Strong, Rosie Hopkins-Campbell, Jean Butel, Barbara E. Ainsworth, Deborah Parra-Medina

Faculty Publications

Background: Objective measurement of physical activity with accelerometers is a challenging task in community-based intervention research. Challenges include distribution of and orientation to monitors, nonwear, incorrect placement, and loss of equipment. Data collection among participants from disadvantaged populations may be further hindered by factors such as transportation challenges, competing responsibilities, and cultural considerations. Methods: Research staff distributed accelerometers and provided an orientation that was tailored to the population group. General adherence strategies such as follow-up calls, daily diaries, verbal and written instructions, and incentives were accompanied by population-specific strategies such as assisting with transportation, reducing obstacles to wearing the accelerometer, …

Physical Activity And Sedentary Activity Patterns Among Children And Adolescents: A Latent Class Analysis Approach, Carrie D. Patnode, Leslie A. Lytle, Darin J. Erickson, John R. Sirard, Daheia J. Barr-Anderson, Mary Story

Faculty Publications

Background: While much is known about the overall levels of physical activity and sedentary activity among youth, few studies have attempted to define clusters of such behaviors. The purpose of this study was to identify and describe unique classes of youth based on their perception in a variety of physical activity and sedentary behaviors. Methods: Latent class analysis was used to characterize segments of youth based on patterns of self-reported and accelerometer-measured participation in 12 behaviors. Children and adolescents (N =720) from 6th-11th grade were included in the analysis. Differences in class membership were examined using multinomial logistic …

Acute Impact Of Moderate-Intensity And Vigorous-Intensity Exercise Bouts On Daily Physical Activity Energy Expenditure In Postmenopausal Women, Xuewen Wang, Barbara J. Nicklas

Faculty Publications

This study determined whether performing a single moderate- or vigorous-intensity exercise bout impacts daily physical activity energy expenditure (PAEE, by accelerometer). Overweight/obese postmenopausal women underwent a 5-month caloric restriction and moderate- (n = 18) or vigorous-intensity (n = 18) center-based aerobic exercise intervention. During the last month of intervention, in women performing moderate-intensity exercise, PAEE on days with exercise (577.7 ± 219.7 kcal·d⁻¹) was higher (P = .011) than on days without exercise (450.7 ± 140.5 kcal·d⁻¹); however, the difference (127.0 ± 188.1 kcal·d⁻¹) was much lower than the energy expended …

Changes In Weight, Waist Circumference And Compensatory Responses With Different Doses Of Exercise Among Sedentary, Overweight Postmenopausal Women, Timothy S. Church, Corby K. Martin, Angela M. Thompson, Conrad P. Earnest, Catherine R. Mikus, Steven N. Blair

Faculty Publications

Background: It has been suggested that exercise training results in compensatory mechanisms that attenuate weight loss. However, this has only been examined with large doses of exercise. The goal of this analysis was to examine actual weight loss compared to predicted weight loss (compensation) across different doses of exercise in a controlled trial of sedentary, overweight or obese postmenopausal women (n=41).

Methodology/Principal Findings: Participants were randomized to a non-exercise control (n=94) or 1 of 3 exercise groups; exercise energy expenditure of 4 (n=139), 8 (n=85), or 12 (n=93) kcal/kg/week (KKW). Training intensity was set at the heart rate associated with …

Maximal Exercise Electrocardiography Responses And Coronary Heart Disease Mortality Among Men With Diabetes Mellitus, G. William Lyerly, Xuemei Sui, Timothy S. Church, Carl J. Lavie, Gregory A. Hand, Steven N. Blair

Faculty Publications

Background - An abnormal ECG during maximal exercise testing has been shown to be a powerful predictor of future coronary heart disease (CHD) mortality in asymptomatic men. However, little is known about the relationship between exercise ECG responses and CHD risk in men with diabetes mellitus.

Methods and Results - We examined the association between exercise ECG responses and mortality in 2854 men with documented diabetes mellitus (mean age 49.5 years) who completed a maximal treadmill exercise test during the period from 1974 to 2001 and who were without a previous cardiovascular disease (CVD) event at baseline. Mortality due to …

Objectively Assessed Associations Between Physical Activity And Body Composition In Middle-School Girls: The Trial Of Activity For Adolescent Girls, June Stevens, David M. Murray, Chris C. Baggett, John P. Elder, Timothy G. Lohman, Leslie A. Lytle, Russell R. Pate, Charlotte A. Pratt, Margarita S. Treuth, Larry S. Webber, Deborah Rohm Young

Faculty Publications

Declining levels of physical activity probably contribute to the increasing prevalence of overweight in US youth. In this study, the authors examined cross-sectional and longitudinal associations between physical activity and body composition in sixth- and eighth-grade girls. In 2003, girls were recruited from six US states as part of the Trial of Activity for Adolescent Girls. Physical activity was measured using 6 days of accelerometry, and percentage of body fat was calculated using an age- and ethnicity-specific prediction equation. Sixth-grade girls with an average of 12.8 minutes of moderate-to-vigorous physical activity (MVPA) per day (15th percentile) were 2.3 times (95% …

Perceived Individual, Social, And Environmental Factors For Physical Activity And Walking, Michelle L. Granner, Patricia A. Sharpe, Brent E. Hutto, Sarah Wilcox, Cheryl L. Addy

Faculty Publications

Background: Few studies have explored associations of individual, social, and environmental factors with physical and walking behavior. Methods: A random-digit-dial questionnaire, which included selected individual, social, and environmental variables, was administered to 2025 adults, age 18 y and older, in two adjacent counties in a southeastern state. Logistic regressions were conducted adjusting for age, race, sex, education, and employment. Results: In multivariate models, somewhat different variables were associated with physical activity versus regular walking. Self-efficacy (OR = 19.19), having an exercise partner (OR = 1.47), recreation facilities (OR = 1.54), and safety of trails from crime (OR = 0.72) were …

Exercise And Cardiovascular Events - Placing The Risks Into Perspective: A Scientific Statement From The American Heart Association Council On Nutrition, Physical Activity, And Metabolism And The Council On Clinical Cardiology, Paul D. Thompson, Barry A. Franklin, Gary J. Balady, Steven N. Blair, Domenico Corrado, N. A. Mark Estes Iii, Janet E. Fulton, Neil F. Gordon, William L. Haskell, Mark S. Link, Barry J. Maron, Murray A. Mittleman, Antonio Pelliccia, Nanette K. Wenger, Stefan N. Willich, Fernando Costa

Faculty Publications

Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with …

Promoting Physical Activity In Children And Youth: A Leadership Role For Schools: A Scientific Statement From The American Heart Association Council On Nutrition, Physical Activity, And Metabolism (Physical Activity Committee) In Collaboration With The Councils On Cardiovascular Disease In The Young And Cardiovascular Nursing, Russell R. Pate, Michael G. Davis, Thomas N. Robinson, Elaine J. Stone, Thomas L. Mckenzie, Judith C. Young

Faculty Publications

No abstract provided.

The Relationship Between Leisure-Time Physical Activity And The Metabolic Syndrome: An Examination Of Nhanes Iii, 1988-1994, Katrina D. Dubose, Cheryl L. Addy, Barbara E. Ainsworth, Gregory A. Hand, J. Larry Durstine

Faculty Publications

No abstract provided.

Revised Adult Treatment Panel Iii Guidelines And Cardiovascular Disease Mortality In Men Attending A Preventive Medical Clinic, Chris I. Ardern, Peter T. Katzmarzyk, Ian Janssen, Timothy S. Church, Steven N. Blair

Faculty Publications

Background - National Cholesterol Education Program Adult Treatment Panel III guidelines recommended therapeutic lifestyle changes (TLC) and drug therapy to reduce cardiovascular disease (CVD) risk. These guidelines have been revised recently (ATP III-R); however, the risk of CVD mortality within each intervention window and the effects of cardiorespiratory fitness (CRF) and metabolic syndrome on CVD mortality within the framework of the guidelines are unknown.

Methods and Results - Risk factor and CRF data from 19,125 men (aged 20 to 79 years) who attended a preventive medical clinic between 1979 and 1995 were used. Mortality follow-up was completed until December 31, …

Cardiorespiratory Fitness Is Inversely Associated With The Incidence Of Metabolic Syndrome: A Prospective Study Of Men And Women, Michael J. Lamonte, Carolyn E. Barlow, Radim Jurca, James B. Kampert, Timothy S. Church, Steven N. Blair

Faculty Publications

Background - Few studies have reported the relationship between cardiorespiratory fitness and metabolic syndrome incidence, particularly in women.

Methods and Results - We prospectively studied 9007 men (mean±SD, age, 44±9 years; body mass index, 25±3 kg/m²) and 1491 women (age, 44±9 years; body mass index, 22±2 kg/m²) who were free of metabolic syndrome and for whom measures of waist girth, resting blood pressure, fasting lipids, and glucose were taken during baseline and follow-up examinations. Baseline cardiorespiratory fitness was quantified as duration of a maximal treadmill test. Metabolic syndrome was defined with NCEP ATP-III criteria. During a …