INTRODUCTION

The metabolic syndrome is a collection of metabolic diseases that includes hypertension, central
obesity, cardiovascular disease, and diabetes mellitus, also the risk of cardiovascular disease
(CVD), coronary artery disease (CAD), and stroke is elevated by metabolic syndrome (Silveira
Rossi et al. 2022), Although it is believed that around 25% of individuals globally suffer from
metabolic syndrome. (Papaioannou, Kadi, and Nilsson 2022).
In adults, the prevalence of the metabolic syndrome ranges from 20 to 25%, with similar rates
between genders (men: 7-34% , women: 5-22%) (Kouvari et al. 2022), while, in children, it
ranges from 0 to 19.2% (Belete et al. 2021), and as is reported as in Finland the highest
prevalence of Metabolic syndrome (57.1%) (Rhee 2022) while the lowest prevalence was in
Poland (3.2%) (Bitew et al. 2021).
Dyslipidemia is the primary cause of the onset and progression of atherosclerotic cardiovascular
disease (ASCVD) (Vanwong et al. 2022), and it is considered the most common sign present
among different metabolic diseases (Berberich and Hegele 2021), patients with dyslipidemia
were identified by elevated serum concentrations of triglycerides (TG), cholesterol, or both, and
also abnormal concentrations of associated lipoprotein species (Shi et al. 2022).
This lipoprotein species are total cholesterol (TC), triglycerides (TG), chylomicrons (CM), very
low-density lipoprotein cholesterol (VLDL-C), intermediate-density lipoprotein cholesterol
(IDL-C),low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol
(HDL-C), those species can be identified by their function, size, density, relative lipid content,
and defining apolipoproteins (Yanai et al. 2022).
AIM OF PAPER
This study aims to find out the correlation between metabolic syndrome, lipid profile, Body
Mass Index (BMI), and waist circumference in Egyptian patients.

MATERIALS AND METHODS

The ethical review committee with no. 30 of the faculty of pharmacy for Girls, Al-Azhar
University institutional review board, Cairo, Egypt (AFMG IRB), reference number: 346,
accepted the research methodology. Sharing was entirely voluntary, and each participant signed
an informed written agreement before being accepted into the research. To ensure participant
confidentiality, data were anonymized and coded.

Participants
This study involved 100 Egyptian patients selected by random sampling technique (males and
females), diagnosed as having different types of metabolic syndrome and Dyslipidemia in
internal medicine department at National Research Center period from 2020 to 2022 in Cairo,
Egypt excluding any other metabolic disorder that might affect the studied parameters, Other
inflammatory diseases, extremes of age, malabsorption syndromes e.g., Crohn’s disease, cystic
fibrosis.
The patients age ranges from 15-65 years with mean average (47.85 ± 8.866433125), Metabolic
syndrome and dyslipidemia patients were diagnosed clinically before taking the sample, As a
control group of 100 people of age from 19-38 years with mean average (29 ± 4.80819) and
socioeconomic background who appeared to be in good health were selected, All patients with
Metabolic Syndrome were undergone the Questionnaire included Personal history , History of
present illness, Family history and Full clinical examination including: General examination and
Hematological and Biochemical test, Anthropometric measurements including height, weight,
and BMI [weight (kg)/height (m2 )] were done using standard protocols.
Hematological and Biochemical tests:
 Blood sample:
After an overnight fast (8–12 hours), 10 mL of venous blood were withdrawn into two
tubes from each individual, the first plain tube was used to collect serum for
determination of renal, hepatic functions and lipid profile, While the second fluoride
tube was used to collect plasma to detect fasting plasma glucose.
The blood was allowed to clot at room temperature before being centrifuged to extract
serum, and serum samples were divided into 500μL aliquots on ice and stored at −80 °C
until used.
 Biochemical test:

Determination of Fasting plasma glucose was measured using the enzymatic colorimetric kit
provided by Bayer Corporation, USA, according to glucose oxidase method (Trinder 1969).
While the renal function test included determination of Serum urea, provided by Bio-Merieux
Company, France, according to the modified Berthelot method (Fahrlaender et al. 1976)
whereas determination of Serum Creatinine was assayed by colorimetric kit provided by
Unilab, Philippines according to (Jaffe 1986).
Moreover, Lipid Profile involved the determination of serum triglycerides, total cholesterol,
HDL-C and LDL-C.
Triglyceride (TG) concentration in serum was measured enzymatically kit that was obtained
from Siemen's health care diagnostics Inc, Germany, according to Fossati method (Fossati and
Prencipe 1982).
Determination of total cholesterol concentration in serum was measured enzymatically using kit
that was obtained from Siemen's health care diagnostics Inc, Germany, according to the method
described in (Heider and Boyett 1978).
Determination of HDL-Cholesterol (HDL-C) concentration in serum was measured
enzymatically kit that was obtained from Siemen's health care diagnostics Inc, Germany,
according to the method of (Finley et al. 1978).
Determination of LDL-Cholesterol (LDL-C) was calculated mathematically according to the
Friedewald formula (William T. Friedewald, Robert I. Levy and A 1972).
Also Liver Enzymes were measured quantitatively by determination of Serum Alanine Amino
Transaminase "ALT" colorimetrically kit provided by BioMed diagnostic, Egypt, according to
method of (Bergmeyer, Scheibe, and Wahlefeld 1978). While Serum Aspartate Amino
Transferase "AST" activity colorimetrically kit provided from BioMed diagnostic, Egypt,
according to the method of (Bergmeyer, Scheibe, and Wahlefeld 1978).
Determination of kidney function by measured serum total creatine kinase activity and this
method is an N-acetyl cysteine (NAC) activated, UV method at 340 nm, using kits provided by
Linear Chemicals S.L.U, Barcelona, Spain (Fisher et al. 1983). This test has been formulated
according to the standardized method described by IFCC. Clin Chem Lab Med 2002.

Results
Clinical and biochemical analysis:
This study comprised 100 Egyptian patients, and their age ranged from 30 to 68 years and 100
healthy controls of age ranged from 19 to 38 years, patients constitute 59% women and 41%
men, matched with 72% women and 28% men in control groups, Body Mass Index (BMI)
showed that 29% of patients were overweight (defined BMI = ≥25–< 30 kg/m2) and 71% were
obese (defined as BMI =≥30 kg/m2) compared to 31% of control participants who were normal
weight (defined as BMI = ≥18–< 25 kg/m2) and 69% of whom were overweight.

Waist circumference showed that all patient were at very high risk (defined as for men more than
102 cm is very high risk, for women more than 88 cm is very high risk) while in control 41% of
women were at low risk and 35% were at high risk while 23% were at very high risk (defined
for women < 80 cm is low risk , 80-88 cm is high risk , more than 88 cm is very high risk) and
90% of men were at low risk and 10% were at high risk (defined for men < 94cm is low
risk ,94-102cm is high risk).

LDL-C shows very high significant values in patients compared to controls with p values =
0.0001, HDL-C shows high significant values in patients compared to controls with p values
= 0.047, TG shows very high significant values in patients compared to controls with p values =
0.0001, Total cholesterol shows very high significant values in patients compared to controls
with p values = 0.0025. (Table 1 and Fig. 1).
Table 1:

Characteristics Controls (n = Patients (n = p-value (< 0.05) Significance

100) 100) is significant
AGE 29 ± 4.808 47.85 ± 0.0001 Very high
8.866 significant

weight 72.16 ± 87.69 ± 0.0001 Very high

12.384 14.815 significant

Hight 160 ± 8.743 158.87 ± 0.0512 Non-significant

5.239

BMI 27 ±3.312 33.195 ± 0.0001 Very high

4.573 significant

Waist 83.22 ± 78 114.3 ± 0.0001 Very high

circumference 10.256 significant

Total Cholesterol 175.08 ± 193.32 ± 0.0025 Very high

(TC) 42.985 39.935 significant

Triglyceride (TG) 138.28 ± 191.24 ± 0.0001 Very high

42.985 79.137 significant
HDL-C 40.03 ± 38 ± 0.0474 Significant
8.423 8.558
LDL-C 102.254 ± 164 ± 0.0001 Very high
40.069 35.543 significant

BMI body mass index, HDL-C high-density lipoprotein cholesterol, LDL-C low-density
lipoprotein cholesterol, Data presented as mean ± SD value and p value.

Figure 1:
 200
180
160
140
120
100
Controls
80
Patients
60
40
20
0

Age Wt Ht BMI WC CHO TG HDL LDL

Schematic representation of the distribution of controls and patient with metabolic syndrome and dyslipidemia with age, weight,
Hight, BMI, waist circumference, total cholesterol, triglyceride, HDL-C and LDL-C. The comparison between healthy control
(n=100) and patient (n=100).

Age in healthy control was in average 29 years and in patient 47.85 years.

The weight (WT) was in average 72.16kg in healthy control and 87.69kg in patient.

The Hight (HT) was in average 160cm in healthy control and 158.87cm in patient.

The body mass index (BMI) was in average 27 kg\cm² in healthy control and 33.19572 kg\cm² in patient.

The waist circumference (WC) was in average 83.22cm in healthy control and 114.3cm in patient.

The total cholesterol (TC) was in average 175.08 mg\dl in healthy control and 193.32 mg\dl in patient.

The triglyceride (TG) was in average 138.28 mg\dl in healthy control and 191.24 mg\dl in patient.

The high-density lipoprotein cholesterol (HDL-C) was in average 40.03 mg\dl in healthy control and 40.36 mg\dl in patient.

The low-density lipoprotein cholesterol (LDL-C) was in average 102.2547 mg\dl in healthy control and 164 mg\dl in patient.

Discussion
Metabolic syndrome (MetS) affects 20–25% of the global population, is a growing public health
concern (Papaioannou, Kadi, and Nilsson 2022), It is the main contributor to cardiovascular risk
factors comprising abdominal obesity, insulin resistance, hypertension, impaired glucose
metabolism, and dyslipidemia (Silveira Rossi et al. 2022).
Traditional characteristics of dyslipidemia include abnormal serum concentrations of cholesterol,
triglycerides, or both, as well as abnormal concentrations of associated lipoprotein species
(Trandafir et al. 2022),
According to Fredrickson classification the hyperlipidemia divided into primary and secondary
subtypes. Primary hyperlipidemia is inherited and is usually due to genetics causes, while
secondary hyperlipidemia is acquired and occurs due to other reasons like diseases such as
diabetes and obesity, or alcohol , drugs like oral contraceptive (William T. Friedewald, Robert I.
Levy and A 1972).
The 5 types of primary hyperlipidemia are;
Type I or familial chylomicronemia is rare and has elevation chylomicron plasma level due to
deficiency in familial lipoprotein lipase and that’s lead to total cholesterol and triglyceride
elevation.
Type II are divided into type IIa and Type IIb.
Type IIa or familial hypercholesteremia, that type is less common in type II hyperlipidemia, its
significates by elevation in LDL-C plasma level and that’s lead to elevation in total cholesterol
and normal triglyceride levels.
Type IIb or familial combined hyperlipidemia, it has elevation in LDL-C and VLDL-C plasma
level and that’s lead to elevation in total cholesterol and normal triglyceride levels.
Type III or familial dysbetalipoprotenemia is rare and has elevation in IDL-C and chylomicron
remanent due to abnormality in apoE lipoprotein which leads to elevated total cholesterol and
triglyceride plasma levels.
Type IV or hypertriglyceridemia, it has elevation of VLDL-C, as a result, the patient will have
elevation of triglyceride plasma level and normal total cholesterol level.
Type V or familial endogenous hypertriglyceridemia, it has elevation of VLDL-C and
chylomicron and so elevation in total cholesterol and triglyceride plasma level.
So according to Frederickson phenotypic, Chylomicrons with the phenotype I abnormalities have
triglycerides that are above the 99th percentile (Merćep et al. 2022), Phenotype IIa mostly
comprises of aberrant LDL-C and will have total cholesterol levels above the 90th percentile and
perhaps over the 90th percentile of apolipoprotein B (Merćep et al. 2022),Very-Low-Density
Lipoprotein cholesterol (VLDL-C) and LDL-C abnormalities make up Phenotype IIb,
Apolipoprotein levels will also exceed the 90th percentile and total cholesterol and/or
triglycerides will be above this range (Glavinovic et al. 2022), Chylomicrons and VLDL-C
remnants with phenotype III abnormalities had increased total cholesterol and triglycerides
above the 90th percentile (Merćep et al. 2022), Phenotype IV is primarily associated with
aberrant VLDL-C, which causes total cholesterol to exceed the 90th percentile (Merćep et al.
2022), When triglycerides are over the 99th percentile and chylomicrons and VLDL-C are
aberrant, the condition is known as phenotype V (Merćep et al. 2022).
The most prevalent chronic illnesses to be identified and treated are dyslipidemias (Alsahly et al.
2022), Although hereditary problems (20%) are significant, food and lifestyle factors account for
the majority (80%) of dyslipidemia (Blom et al. 2022), while the prevalence of
hypercholesterolemia in the Egyptian population was 19.4%, 36.8%, and 19.2% in 2006, 2012,
and 2017, respectively, according to data from a national survey (Reda et al. 2021), Egyptian
individuals with Coronary Artery Disease (CAD) also had a high prevalence of dyslipidemia
(58.7%) based on total cholesterol values (Reda et al. 2021).
Body mass index (BMI), which measures weight to height, is the most generally used and
simplest measure of body size, and it is routinely used to determine the prevalence of obesity in a
community (Moosaie et al. 2021).
In the current study, 100 Egyptians with metabolic syndrome and dyslipidemia were included,
the majority of patients were female (59% of cases), and obesity was prevalent (71%); however,
overweight was 29%, in comparison to control groups, which had 72% women and 28% males,
the patient group had 59% women and 41% men, according to body mass index (BMI), 29% of
patients were obese and 71% were overweight, when compared to controls.
Waist circumference showed that all patient were at very high risk while in control 41% of
women were at low risk and 35% were at high risk while 23% were at very high risk and this
result matching with V. Wietlisbach which found that the dyslipidemia was strongly associated
with body mass index (BMI) in men and with waist circumference (WC) in women while a
strong association with low HDL-C was observed for both indicators of adiposity (Wietlisbach et
al. 2013).
In our finding LDL-C in patients exhibits extremely high significant levels, with p values =
0.0001, with p values = 0.0474, HDL-C in patients exhibits highly significant values when
compared to controls. when TG is compared to controls, patients exhibit very high significant
values (p values = 0.0001), With p values = 0.0025, total cholesterol in patients exhibits
extremely high significant levels when compared to controls, while TG was found to correlate
with the adiposity measures more strongly than total cholesterol and LDL-C in epidemiological
studies (Moosaie et al. 2021) (Krause et al. 2007), although no such correlations were found in a
Sikh population (Lovegrove et al. 2003).
In this study Age in healthy control was in average 29 years and in patient 47.85 years while
Xiang said due to the role dyslipidemia plays in atherogenesis and the fact that its negative
effects on health worsen with ageing (Xiang et al. 2022), the risk of atherosclerosis and coronary
heart disease is increased by dyslipidemia (Gharib et al. 2022),moreover, Cho found that all
dyslipidemia parameter worsened with older age (Cho et al. 2020) and this is consistent with the
result of our research.
Dyslipidemia strikes women 10 to 15 years later than it does men, likely because ovarian
hormones have a protective impact (particularly E2), and they found that Obesity is a major
public health concern that affects women disproportionately more than men, and abdominal fat
accumulation following menopause is linked to a worse lipid profile, additionally,
postmenopausal women have higher levels of triglycerides and LDL-C, two factors that
contribute to the atherosclerosis process (Marlatt et al. 2022).
The reported prevalence of dyslipidemia in the overall Egyptian population was substantially
lower than the expected prevalence of 39% given by the WHO. Also, prevalence of high
cholesterol in Egypt was comparatively lower than that reported in the USA (55%) and UK
(66%) (Reda et al. 2021).
The frequency of dyslipidemia in women above 40 years old is four times women under 40 years
old, according to research of approximately 1000 women conducted in Korea (Kim et al. 2022),
while In this study the women were 59%, women above 40 years old were 48%, overall female
who have hypertriglyceridemia was 80%, hypercholesterolemia was 34%, low HDL-C was 91%,
and high LDL-C was 14%, while men was 41%, overall male who have hypertriglyceridemia
was 78%, hypercholesterolemia was 51%, low HDL-C was 95%, and high LDL-C was 22%.
According to the Adult Treatment Panel III criteria of the National Cholesterol Education
Program and Urban residence the prevalence of dyslipidemia overall was 63.8%,
hypercholesterolemia was 38.8%, hypertriglyceridemia was 29.7%, low HDL-C was 27.1%, and
high LDL-C was 33.1% (Abdel Wahed, El-Khashab, and Hassan 2016).
On the other hand, Reda found the prevalence of dyslipidemia was consistently higher in the 51–
59% range among Egyptian patients with Acute Coronary Syndrome (ACS) and Coronary Artery
Disease (CAD), reinforcing the condition's standing as a significant risk factor for CVDs (Reda
et al. 2021).

Conclusions
This study provides clinical evidence that Total Cholesterol, triglyceride, LDL-C, HDL-C, BMI,
WC were remarkably correlated to metabolic syndrome and dyslipidemia. Our findings
suggested that further demographic studies should be done to understand more about metabolic
syndrome and dyslipidemia; this will improve the diagnosis of cardiovascular disease and reduce
mortality.

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