الفهرس 
Metabolic SyndromeOnly 14 pages are availabe for public view
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Abstract
Metabolic syndrome (MetS) (insulin resistance syndrome) is a multifactorial disease with multiple risk factors that arises from insulin resistance and adipose tissue dysfunction with abnormal deposition (Hernandez-Baixauli et al., 2020).
Although the etiology for metabolic syndrome remains unclear (Ogden et al., 2015), there are two forces that have implicated in the spread of metabolic syndrome which are the increased availability and consumption of high calorie-low fiber fast food and decreased physical activity because of sedentary lifestyles and mechanized transportation (Saklayen, 2018).
There are several mechanisms for the pathophysiology of MetS, and the most widely accepted of these is insulin resistance with fatty acid excess as a consequence of inappropriate lipolysis. Other mechanisms involved in development of MetS include genetics and epigenetics, pancreatic β-cell dysfunction, obesity and lipid Toxicity, oxidative stress and glucose toxicity, chronic inflammation, circadian rhythm, gut microbiota and dietary effects (Hang et al., 2019).
Most of the individuals with metabolic syndrome don’t have obvious signs or symptoms. Large waist circumference may be the only visible sign. If the blood sugar is high, signs and symptoms of diabetes may be present, such as increased thirst and urination, fatigue, and blurred vision (Stanley et al., 2020).
Currently the changes in mean platelet volume (MPV) can be considered and used as a prognostic factor in various inflammatory diseases. Hyperactivity of blood platelets markedly increases susceptibility of patients to acute cardiac incidents. Large and reactive platelets increase the risk of thrombus formation because it has greater amount of cell granules, higher expression of adhesion molecules, and undergoes faster activation, which results in platelet hyperactivity and increased risk of clot formation. So, elevated MPV correlates with increased platelet aggregation, increased synthesis, and release of thromboxane (TXA2) and β-thromboglobulin (Braekkan et al., 2010, Elsenberg et al, 2017).
Management of MetS involves a combination of life style modification and pharmacological interventions. Life style modifications, including dietary control and physical activity which are important for regulation of all components of MetS resulting in decreased weight, blood pressure, triglycerides, and fasting glucose levels and raising HDL cholesterol levels (Rochlani et al., 2017, Pérez et al., 2019, Guna & Hye, 2020).
High-intensity interval training (HIIT) is defined as an intermittent style of exercise training involving short bursts of high-intensity exercise that achieves ≥90% of maximal heart rate (HR) separated by periods of recovery or rest (Wewege et al., 2017, Reljic et al 2021). This exercise model has been ranked number 1 in the health and fitness trends in 2018 due to its time-saving nature (Thompson, 2018, Atakan et al., 2021).
The beneficial impact of HIIT on metabolic health is improving vascular and cardiorespiratory fitness, fat loss, insulin sensitivity, and reducing diabetes risk (De Nardi et al., 2018, Viana et al., 2019)
Ultrasonic Cavitation (UC) and radiofrequency (RF) are FDA approved devices for local adiposity reduction. Ultrasonic waves generate compression cycles that exert positive and negative pressure. This pushing and pulling effect can crack the fat cells. Ultrasonic energy within the deeper fat layers causes cavities in the fat cell that reduces the overall thickness of the adipose layer. The mechanical acoustic effects of ultrasound cavitation caused selective fat cell disruption without causing injury to skin, vessels, nerves or connective tissue (Melvin et al., 2016).
The mechanism of the therapeutic effect of RF is via increasing the flow of the local blood supply to the adipose tissue. Also, RF cause contraction of collagen fibers, remodeling of connective tissue and activation of fibroblast (Naeimi et al., 2019)
This study aims to compare between the effect of combined ultrasound cavitation and radiofrequency versus high-intensity interval training exercise on anthropometric indices in centrally obese MetS patients, confirm the association between MPV and the risk factors of development of cardiovascular disease such as BMI, waist circumference, dyslipidemia, hypertension and insulin resistance, measure the effect of abdominal fat reduction on MPV as a biomarker for cardiovascular risk and measure the effect of abdominal fat reduction on lipid profile and insulin resistance in centrally obese MetS patients.
This study was carried out on forty patients attending to Physical medicine, Rheumatology and Rehabilitation department clinic with age range from 30 to 55 years old diagnosed with metabolic syndrome having abdominal obesity according to the diagnostic criteria used to classify MetS patients (Grundy et al., 2005).
Metabolic syndrome is present if three or more of the following criteria are met.
1. Abdominal obesity: ≥102 cm (>40 inches) in males ≥88 cm (>35 inches) in females
2. Raised triglyceride levels: ≥ 150 mg/dL
3. Reduced HDL levels: < 40 mg/dL in men and < 50 mg/dL in women
4. Raised BP: ≥ 130 mm Hg systolic or ≥ 85 mm Hg diastolic
5. Raised fasting glucose levels: more than 100mg/dL.
All patients were fulfilling criteria number 1.
Patients were divided into two equal groups randomly (group A & B). Patients of group A was treated using UC combined with RF using Mable 6 Duo Ultra cavitation and Multipolar RF system, one session per week for eight weeks (8 sessions). Patients of group B were on high intensity interval training exercise for 8 weeks (three sessions per week). Assessment was done for both groups at day one and follow up after 8 weeks by clinical and laboratory measures.
Both groups showed a highly statistically significant improvement in clinical assessment parameters including waist circumference, weight, WHR, BMI, skin fold thickness, abdominal fat range, body fat Percentage, and blood pressure (SBP & DBP) except skeletal muscle mass showed non-significant change in group A. Also, both groups showed highly statistically significant improvement in laboratory assessment parameters including MPV, lipid profile, fasting glucose, fasting insulin and HOMA-IR (except LDL in group B there was a non-significant change).
On comparing group A and group B as regards clinical parameters. There was higher improvement (reduction) in waist circumference, WHR, skin fold thickness and abdominal fat range in group A more than group B and higher improvement (reduction) in body weight, BMI,total body fat % and blood pressure (SBP &DBP) in group B more than group A.
Although both groups interventions were effective in reducing all anthropometric indices, combined UC & RF sessions were more effective for reshaping and reducing abdominal obesity, while HIIT sessions were more effective in reducing total body weight, BMI and total fat percentage.
The combined therapy named ‘ultrafrequency’ promotes synergistic effect on reduction of adiposity as UC facilitates lipolysis and RF immediately propels intercellular fat content to lymphatic circulation by heating and improving circulation. On the other hand, a low-calorie diet prevents the body from receiving more fat. Mixture of UC treatment and low-calorie diet results in a higher productivity than a low-calorie diet alone in bringing down the anthropometric, complete body arrangement and plasma liopoprotein factors (Sabbour & Elbanna, 2009, Safari Bidokhti et al., 2019, Silva et al., 2022).
On comparing group A and group B as regards blood pressure, the reduction in systolic and diastolic blood pressure was more apparent in group B than group A. That suggests that HIIT sessions were more effective in reducing systolic and diastolic blood pressure than combined UC & RF.
On comparing group A and group B as regards laboratory parameters. There was more prominent reduction in fasting glucose, fasting insulin & HOMA-IR in group B than group A. That’s means a highly significant improvement in insulin resistance after HIIT exercise sessions more than after UC & RF sessions
Also, there was higher improvement in MPV and lipid profile (especially cholesterol) in group B more than group A. That could suggest that HIIT exercise sessions better to improve cholesterol level more than UC & RF sessions.
This study confirms positive correlation between MPV and waist circumference, weight, WHR, BMI, skin fold thickness, abdominal fat range, body fat Percentage, systolic blood pressure, diastolic blood pressure, cholesterol, TG, LDL, Cholesterol: HDL ratio, fasting glucose, fasting insulin and HOMA-IR and negative correlation between MPV and HDL before and after treatment in all patients. That is means that MPV can be a diagnostic and also prognostic biomarker for all these risk factors useful in longitudinal studies.
This current study supports that combined UC & RF sessions are very effective in reducing abdominal obesity and improvement in other MetS variables such as dyslipidemia, hypertension, hyperglycemia and insulin resistance. However, HIIT exercise was superior in reducing total body weight, total body fat, BMI and superior in improving (reducing) blood pressure, MPV, cholesterol level, blood glucose and insulin resistance.