A rapid decline in renal function can cause many complications, and therefore it is important to detect associated risk factors. Few studies have evaluated the associations among obesity-related indices and metabolic syndrome (MetS) with renal function decline. This longitudinal study aimed to explore these relationships in a large cohort of Taiwanese participants. The studied obesity-related indices were waist-to-height ratio (WHtR), A body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), body roundness index (BRI), conicity index (CI), body mass index (BMI), body adiposity index (BAI) and abdominal volume index (AVI). We included 122,068 participants in the baseline study, of whom 27,033 were followed for a median of four years. The baseline prevalence of MetS was 17.7%. Multivariable analysis showed that the participants with MetS and high VAI, WHtR, WHR, LAP, CI, BRI, BMI, BAI, AVI, and ABSI values were significantly associated with a high baseline estimated glomerular filtration rate (eGFR) (all p < 0.001). In addition, the participants with MetS (p < 0.001), high WHtR (p = 0.007), low LAP (p < 0.001), high BRI (p = 0.002), high CI (p = 0.002), high AVI (p = 0.001), high VAI (p = 0.017), and high ABSI (p = 0.013) were significantly associated with a low △eGFR, indicating a rapid decline in renal function. These results showed associations between MetS and high values of obesity-related indices except LAP with high baseline eGFR and rapid decline in kidney function. These findings suggest that screening for MetS and obesity may help to slow the decline in renal function in high-risk populations.

Cataract is the leading cause of blindness worldwide, and metabolic syndrome (MetS) is a known risk factor. In this study, we investigated the association between the risk of cataract with MetS and its components in a large-scale study. Data were derived from the Taiwan Biobank, and 121,380 individuals were included. The NCEP-ATP III criteria modified for use in an Asian population were used to define MetS and its components. The occurrence of cataract was identified through a standardized interview and self-reported questionnaire. Multivariable analysis showed that MetS (OR, 1.129; 95% CI, 1.0175–1.184; p < 0.001), low high-density lipoprotein (HDL)-cholesterol (OR, 1.057; 95% CI, 1.005–1.113; p = 0.032), and hyperglycemia (OR, 1.162; 95% CI, 1.108–1.218; p < 0.001) were significantly associated with cataract. Furthermore, a stepwise increase in the prevalence of cataract corresponding to the number of MetS components was found. The presence of three MetS components (vs. 0; OR, 1.103; 95% CI, 1.024–1.188; p = 0.010), four MetS components (vs. 0; OR, 1.137; 95% CI, 1.040–1.242; p = 0.005), and five MetS components (vs. 0; OR, 1.208; 95% CI, 1.059–1.378; p = 0.005) were significantly associated with cataract. In conclusion, significant associations were found between a high incidence of cataract with MetS and its components, including low HDL-cholesterolemia and hyperglycemia. Further, a stepwise increase in the prevalence of cataract corresponding to the number of MetS components was also found. The results of this study indicate that MetS may increase the development of cataract in Taiwan.

Rationale: Hypoglycemia is an emergent condition with many causes, including underlying diabetes mellitus either with the use of insulin or oral anti-diabetic medications for glucose control, and organ (heart, hepatic, or renal) failure. Insulin autoimmune syndrome (IAS) can also cause hypoglycemia, however it is relatively difficult to diagnose as it is rare clinically. Although uncommon, IAS can be life threatening in patients with persistent hypoglycemia. Patient concern: We report the case of a 27-year-old female with underlying Graves’ disease who was treated with methimazole (MTZ). After 6 weeks of treatment, she developed hypoglycemia symptoms accompanied by dizziness and cold sweating. We excluded underlying diabetes mellitus, the use of insulin or oral anti-diabetic medications, and organ failure. Diagnoses: Laboratory data showed elevated insulin and C-peptide levels. Therefore, insulinoma and IAS were suspected. Abdominal computed tomography and magnetic resonance imaging ruled out insulinoma, and MTZ-induced IAS was finally diagnosed. Interventions and outcomes: The hypoglycemia symptoms resolved after MTZ was switched to propylthiouracil, confirming the diagnosis of IAS. Lessons: This case emphasizes the significance of life-threatening MTZ-induced IAS. IAS should be suspected in patients who develop spontaneous hypoglycemia, especially in those with underlying Graves’ disease receiving MTZ who present with hyperinsulinism.