Date Published: August 21, 2018
Publisher: Public Library of Science
Author(s): Ga Eun Nam, Seon Mee Kim, Kyungdo Han, Nan Hee Kim, Hye Soo Chung, Jin Wook Kim, Byoungduck Han, Sung Jung Cho, Ji Hee Yu, Yong Gyu Park, Kyung Mook Choi, Ronald C. W. Ma
Abstract: BackgroundThe association of metabolic syndrome (MetS) with the development of Parkinson disease (PD) is currently unclear. We sought to determine whether MetS and its components are associated with the risk of incident PD using large-scale cohort data for the whole South Korean population.Methods and findingsHealth checkup data of 17,163,560 individuals aged ≥40 years provided by the National Health Insurance Service (NHIS) of South Korea between January 1, 2009, and December 31, 2012, were included, and participants were followed up until December 31, 2015. The mean follow-up duration was 5.3 years. The hazard ratio (HR) and 95% confidence interval (CI) of PD were estimated using a Cox proportional hazards model adjusted for potential confounders. We identified 44,205 incident PD cases during follow-up. Individuals with MetS (n = 5,848,508) showed an increased risk of PD development compared with individuals without MetS (n = 11,315,052), even after adjusting for potential confounders including age, sex, smoking, alcohol consumption, physical activity, income, body mass index, estimated glomerular filtration rate, and history of stroke (model 3; HR, 95% CI: 1.24, 1.21–1.27). Each MetS component was positively associated with PD risk (HR, 95% CI: 1.13, 1.10–1.16 for abdominal obesity; 1.13, 1.10–1.15 for hypertriglyceridemia; 1.23, 1.20–1.25 for low high-density lipoprotein cholesterol; 1.05, 1.03–1.08 for high blood pressure; 1.21, 1.18–1.23 for hyperglycemia). PD incidence positively correlated with the number of MetS components (log-rank p < 0.001), and we observed a gradual increase in the HR for incident PD with increasing number of components (p < 0.001). A significant interaction between age and MetS on the risk of incident PD was observed (p for interaction < 0.001), and people aged ≥65 years old with MetS showed the highest HR of incident PD of all subgroups compared to those <65 years old without MetS (reference subgroup). Limitations of this study include the possibilities of misdiagnosis of PD and reverse causality.ConclusionsOur population-based large-scale cohort study suggests that MetS and its components may be risk factors of PD development.
Partial Text: Metabolic syndrome (MetS) refers to a cluster of several interrelated risk factors for cerebrocardiovascular diseases that result in insulin resistance. These metabolic abnormalities frequently coexist, and MetS is prevalent among patients with obesity and/or a sedentary lifestyle [1,2]. MetS prevalence has been continually increasing in recent decades, globally and in the Republic of Korea (South Korea), due to the obesity epidemic . Each metabolic abnormality predicts both type 2 diabetes and cardiovascular disease, and having a cluster of the abnormalities imposes additional risk in addition to the risks associated with the individual abnormalities [1,2]. In addition, MetS increases all-cause mortality risk and the burden of healthcare costs . Recent evidence has indicated that increased oxidative stress is a major characteristic of MetS-related diseases . Therefore, components of MetS may contribute to the pathophysiology of Parkinson disease (PD), which also shows high levels of reactive oxygen species .
Our population-based large-scale cohort study revealed that the incidence rate of PD was approximately 2.2 times greater for people with MetS compared to those without MetS over a 5.3-year follow-up period and that individuals with MetS had a 24% higher risk of incident PD. The presence of each MetS component was also associated with increased risk of PD development, and individuals with a higher number of MetS components were at higher risk of incident PD. These associations persisted even after adjusting for potential confounding variables. Furthermore, increased risk of PD was observed for individuals ≥65 years old compared to younger individuals (<65 years); older individuals with MetS showed the greatest risk of PD. These associations were particularly prominent in women. Source: http://doi.org/10.1371/journal.pmed.1002640