James Meigs Discusses the Rise of Metabolic Syndrome in the US

Special Topic of Metabolic Syndrome Interview, July 2011

James B. MeigsAccording to our Special Topics analysis of Metabolic Syndrome research published over the past decade, the work of Dr. James Meigs ranks at #8 by papers and #14 by cites, based on 61 papers cited a total of 3,370 times during the analysis period. In Essential Science IndicatorsSM from Thomson Reuters, his work ranks among the top 1% of researchers in the fields of Clinical Medicine and Agricultural Sciences.

Meigs is an Associate Professor of Medicine at Harvard Medical School, Assistant Physician in the General Medicine Division and Diabetes Research Unit at Massachusetts General Hospital (MGH), Co-Director of the MGH Clinical Research Program's Clinical Effectiveness Research Group, and an Associated Researcher in Medical and Population Genetics at the Broad Institute.

Below, he talks with ScienceWatch.com about his highly cited work as it relates to metabolic syndrome.

SW: Please tell us about your educational background and research experiences.

For more than 16 years my major research interest has been the cause and prevention of type 2 diabetes (T2D) and cardiovascular disease (CVD). Approaches include biochemical and genetic epidemiology of insulin resistance, T2D, and CVD, and health services translational research to improve T2D and CVD prevention and clinical care.

I have authored more than 300 peer-reviewed scientific articles, editorials, review articles, and book chapters and presented scores of lectures nationally and internationally. My research is supported by multiple NIH and foundation research grants. Over the past decade I have mentored over 40 junior clinical research investigators, of whom almost all have remained in academic medicine and/or continue to participate in clinical research. My mentoring efforts are supported in part by an NIDDK K24 award. In 2009, I was awarded the American Diabetes Association's Kelly West Award for Outstanding Achievement in Diabetes Epidemiology.

I currently am an Associate Editor for the journal Diabetes Care, the Chair of the American Diabetes Association's Scientific and Medical Programs Oversight committee, a Member of the ADA's Medicine, Science and Health Care Awards Committee, vice-Chair of the American Heart Association's CVD Epidemiology and Prevention Spring Program Planning Committee, an appointed member of the NIH/NIDDK Study Section 'Kidney, Nutrition, Obesity, and Diabetes', a Steering Committee Member of the NIDDK National Diabetes Data Group's Diabetes in America 3rd Ed, and a member of two NIH clinical trials DSMBs.

"Those of us interested in disease prevention would like to see a stronger emphasis put on research funding and health-care system insurance-supported clinical prevention programs aimed at reducing the occurrence of metabolic syndrome and its complication."

I am former Chair of the ADA's Epidemiology and Statistics Council, former member of the ADA's Professional Practice Committee, former member of the AHA's Statistics Committee, and former Associate Editor of the journal Obesity, among many national leadership positions.

In addition, for over 20 years I have been a practicing primary care general internist in the MGH Internal Medicine Associates.

SW: What first drew you to work with metabolic syndrome?

My major research interest over my entire career has been the cause and prevention of T2D and CVD. Fifteen years ago the link between T2D and CVD was not clear, but our work and others identified what has come to be called "metabolic syndrome" as a key risk state leading to the development of these two common chronic diseases.

SW: Your most-cited original article is the 2001 Clinical Infectious Diseases paper you coauthored, "Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy," (Hadigan C, et al., 32[1]: 130-9, 1 January 2001). Would you tell us a bit about this paper—your expectations going in, your findings, where this work has gone since this publication? Does metabolic syndrome differ in people with HIV?

This paper is the work of my colleagues Colleen Hadigan and Steven Grinspoon; I was fortunate to be able to contribute non-HIV-infected control individuals through my collaboration with the Framingham Heart Study.

Now that patients with HIV infection live very long lives, other chronic diseases like T2D and CVD have become important in HIV management. Patients with HIV infection seem to have a greater burden of metabolic risk than non-infected individuals. This may be due to fat redistribution associated with some anti-retroviral therapies, direct effects of some of these drugs themselves, the heightened chronic inflammatory state associated with HIV infection, or other poorly understood factors.

It is becoming apparent that the "metabolic syndrome" associated with HIV infection is a risk factor for T2D and CVD, as in non-infected individuals. So, in many ways metabolic syndrome in HIV infection is similar to that in non-infected individuals, although some aspects of the development of metabolic syndrome in HIV are different.

SW: In fact, several of your highly cited papers have to do with the Framingham Offspring Study. Could you give us an overview of this study, and tell us what sort of discoveries or advances in metabolic syndrome might have come about from it over the years?

The Framingham Heart Study was begun over 60 years ago, and in 1972 the children and spouses of the children of the original Framingham Heart Study participants were enrolled in the "Offspring" study. The Framingham Offspring Study includes about 4,000 primarily white individuals who have now been followed for ~40 years for the development of cardiovascular diseases (like heart attack and stroke) and their risk factors (like T2D).

The Framingham Offspring Study has taught us that metabolic syndrome is common, is a common risk factor for the development of both T2D and CVD, that the presence of metabolic syndrome in an individual is an excellent predictor of eventual T2D, but at best a modest predictor of CVD; and that key factors underlying metabolic syndrome are obesity and insulin resistance, among other discoveries.

SW: How big of a societal problem/threat is metabolic syndrome in the US, in your opinion?

"It is safe to say that metabolic syndrome is a major threat to the health of Americans and to the US health care system."

The Framingham Heart Study has also shown us that the prevalence of obesity has risen dramatically over time, that this increase has caused an increase in T2D, and that the increase in T2D has caused a significant increase in CVD. Another way to view the data is that metabolic syndrome has become more common in communities in the US over past decades, especially the past 10-15 years, and that this increase is driving up rates of diabetes, heart attack, and death from cardiovascular diseases. It is safe to say that metabolic syndrome is a major threat to the health of Americans and to the US health care system.

It is important to note that the Framingham Heart Study includes only white individuals. Minority populations like African Americans and Latinos are even more strongly affected by obesity and metabolic syndrome and are even more strongly threatened by the adverse health consequences of metabolic syndrome.

SW: How has the field as a whole changed over the past 10 years? Would you say we are in a better position today in terms of our knowledge of metabolic syndrome than we were in the 1990s? Why or why not?

Metabolic syndrome has become more widely accepted as a metabolic risk state, even if researchers and professional associations do not completely agree on why it is caused or how precisely to define it. We still have a lot of work to do to understand the specific causes of metabolic syndrome. It is clear that unhealthy eating, weight gain, and sedentary lifestyles are associated with development of obesity and metabolic syndrome, but the specific underlying molecular and physiological factors explaining this observation are still being uncovered.

Also, because prevention is not valued or paid for by most US health care system payors, it has proven to be very hard to implement effective means to reduce the occurrence or adverse consequences of metabolic syndrome. So, while we are better able to identify metabolic syndrome, in part thanks to the strenuous efforts by professional organizations like the American Diabetes Association, the American Heart Association, and others, the increasing prevalence of metabolic syndrome in recent years argues that we are in many ways in a worse position than we were in the past in terms of controlling metabolic syndrome.

SW: Where do you hope to see this research go in the next decade?

Those of us interested in disease prevention would like to see a stronger emphasis put on research funding and health-care system insurance-supported clinical prevention programs aimed at reducing the occurrence of metabolic syndrome and its complications. We need to understand better how to help individuals live healthier lifestyles and avoid weight gain that leads to metabolic syndrome. Another important research direction is to better understand the molecular, physiological, and genetic factors that predispose to development of metabolic syndrome and its complications.

James B. Meigs, M.D., M.P.H.
Harvard Medical School
General Medicine Division
Massachusetts General Hospital
Boston, MA, USA


Thom T, et al., "Heart disease and stroke statistics—2006 update—a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee," Circulation 113(6): E85-151, 14 February 2006 with 954 cites. Source: Essential Science Indicators from Clarivate Analytics.



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