1. ABSTRACT Most of the components of metabolic syndrome (MS) course with some inflammatory activity that may lead to physical disabilities. PURPOSE: To determine the distribution of MS patients among low (  P25) and high (  P75) values of laboratory markers of inflammatory state and physical fitness. METHODS: 139 subjects, 35 males and 104 females, 35-84 years of age, volunteers (that signed up an informed consent) for a lifestyle changing program, were assessed for body composition, plasma biochemistry (including CRP- hs and uric acid), hand grip strength and treadmill stress test (for VO 2 máx. by Balke protocol). RESULTS: The distribution of the five diagnostic components of MS (ATP III, 2001) followed the sequence: 79 high abdominal fat (WC), 72 high blood pressure (BP), 64 hypertriglyceridemia (TG), 57 low HDL-cholesterol levels (HDL) and 15 hyperglicemia (Gli). Nineteen subjects (13,7%) had all five components within the normal range, 43 (30,9%) showed two altered components and 48 (34,3%) had at least three (MS).

2. The prevalence of MS was found similar (p > 0.005) in males (42,9%) and females (30,8%) and between individuals under (31,2%) and above (39,%) 60 years of age. Among the MS group the frequency of altered components followed the sequence: WC (40), BP (38), TG (37), HDL (34) and Gli (12). Under lower values (P25) of CRP-hs (0.128mg/dL) and uric acid (4.2mg/dL) the prevalence of female patients with MS differed significantly from those without MS (MS < non MS). On the other hand both groups showed similar prevalence at  P75 for both CRP-hs (  0.6mg/dL) and uric acid (  6.2mg/dL). The prevalence of MS was also smaller among female (p < 0.0001) presenting higher values (  P75) of VO 2 máx. (  42,9mL.kg -1.min. -1 ). CONCLUSIONS: MS similarly distributed between gender and ages (above 35 years) had the females discriminated by its inflammatory activity and/or aerobic fitness with high VO 2 máx. to be considered a protecting factor against MS. Supported by CNPq and FAPESP ABSTRACT (cont.)

3. Western Diet Dietary Fat Glucose surplus ↑FA synthesis ↑ [intracell FA] Cell steatosis ↑ VLDL secretion NFκB/IKκ Cytokines (pro-inflammatory) ↑ C-reactive protein Pro-oxidative state Atherogenic lipid profile Large VLDL Small dense LDL Low HDL level Skeletal muscle waste a.a. ↑ neoglucog. ↑ glucemia ↓ pparα ↓ β oxidation ↓ AMP-k ↓ adiponectin ↓ IRS1/2 Insulin resistance ↓ Glut4 ↓ glucose uptake ↓ AMPk ↑ Hcy ↓ VO2máx. INTRODUCTION Mostly of the metabolic syndrome components course with inflammatory acitvity that way lead to physical disabilities

4. OBJECTIVE To determine the distribution of MS patients among high and low levels of inflammatory markers and fitness index

5. SUBJECTS 139 patients (35-84 yrs) 35 males 104 females Informed consent was obtained from all patients and the study was approved by the local Research Ethics Committee (FMUNESP - Botucatu-SP)

6. METHODS  Body weight, height, fat composition (electrical bioimpedance) and waist circumference  Plasma bio chemistry glucose, triglycerides, HDL – cholesterol, uric acid(dry chemistry), homocysteine (HPLC) and C. Reactive Protein (hs quimio luminescense)  Hand grip strength (dynamometer) and treadmill stress test (Balke protocol)  Metabolic syndrome diagnosis three or more of the abnormalities (ATPIII, 2001): waist circumference > 102 cm (  ) or > 88 cm (  ), high blood pressure  130 mmHg (SBP) and/or  85 mmHg (DBP), triglycerides  150 mg/dL, glucose  110 mg/dL, and HDL cholesterol < 40 mg/dL (  ) or < 50 mg/dL (  )  Statistical analysis: Kruskal Wallis

7. 79 72 64 57 15 waist circunf blood hypert high TG low HDL high glucose RESULTS Figure 1. Distribution of five diagnostic components of the metabolic syndrome n

8. Figure 2. Numbers of altered components of metabolic syndrome 13,7 21,6 30,9 22,3 8,6 2,9 0 1 23 45 altered components % RESULTS (cont.)

9. Figure 3. Distribution of metabolic syndrome among genders and aging males p=0.42 females p=0.0005 < 60 yrs p=0.0009  60 yrs p=0.15 % RESULTS (cont.)

10. Figure 4. Prevalence of metabolic syndrome between genders and aging groups % 50 42,9 30,8 38,2 39,1 males < 60 yrs p>0.05 RESULTS (cont.) females  60 yrs

11. Figure 5. Frequency of altered components in the metabolic syndrome group  WC  HDL  BP  TG  Glu 24,8 23,6 23,0 21,1 7,5 RESULTS (cont.)

12. without MS with MS p values PCR  P25 (0.13mg/dL) 70,4%29,6% p = 0.060  P75 (0.60gm/dL) 46,2%53,8% p = 0.69 URIC  P25 (4.2mg/dL) 81,5%18,5% p = 0.012 ACID  P75 (6,2mg/dL) 58,6%41,4% p = 0.35 VO 2 máx  P25 (24,9mg/dL) 51,7%48,3% p = 0.83  P75 (42,9mg/dL) 87,1%12,9% p = 0.003 HAND  P25 (24kg) 74,1%25,9% p = 0.034 GRIP  P75 (36kg) 55,6%44,4% p = 0.48 Table 1. Distribution of the female metabolic syndrome prevalences between low (p  25) and high (p  75) quartiles of CRP-hs, uric acid and VO 2 máx RESULTS (cont.)

13. CONCLUSIONS Higher inflammatory pro-oxidative markers and lower aerobic/upper strength fitness index discriminated the presence of metabolic syndrome only in females. Higher VO 2 máx might be considered a protecting factor against metabolic syndrome.