Metabolic syndrome definitions [9].
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Metabolic Syndrome (MetSy) is one of the fastest-growing non-communicable disorders globally [1, 2]. Metabolic syndrome (MetSy) is a precursor to Non-communicable Diseases (NCDs) and is responsible for the high prevalence of chronic diseases like diabetes, hypertension, heart conditions and cerebrovascular incidents. The burden of NCDs is rising globally and is becoming worse in developing countries, where more women than men are at risk. Women also bear the greatest morbidity and mortality in almost all countries [2]. By the year 2030, studies project that NCDs and related diseases will be the cause of more than 75% of deaths globally [3]. Cardiovascular diseases (CVDs) are predicted to be the future major cause of deaths in low-income countries, more than all the infectious diseases, maternal and perinatal conditions, and nutritional disorders combined [2, 3]. The risk factors associated with NCDs include smoking, high blood pressure, unhealthy diet, inactivity, overweight and obesity, hypercholesterolemia, elevated blood sugar and alcohol consumption [4].
In 2016, the WHO recorded 39% of adults aged 18 years and over (39% of men and 40% of women) to be overweight and on the whole about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2016 [5]. Obesity and overweight). The worldwide prevalence of obesity nearly tripled between 1975 and 2016 [5]. Obesity in men in reproductive age is increasing worldwide, impacting negatively on reproductive potential, sperm function and assisted reproduction outcomes. Changes in modern eating behaviors are needed to invert the negative correlation between lifestyle and sperm quality [6]. Current studies predict that approximately 25% of children less than 16 years old will be obese by the year 2050. This is of serious concern as childhood obesity predisposes individuals to adult obesity and the associated obesity related medical sequelae. One such sequela is the impact on reproductive health in both the male and females population [7].
Metabolic syndrome (MetSy) presents as a group of interrelated factors that increases the risk of acquiring cardiovascular disease (CVD) such as coronary heart disease (CHD), arterial atherosclerotic vascular disease and type-2 diabetes mellitus (T2DM), which was described as “Syndrome X” by Reaven in 1988. “Syndrome X” was characterized by impaired glucose tolerance (IGT), hyperinsulinemia, elevated triglycerides (TG), and reduced high-density lipoprotein cholesterol (HDLc) [8]. To date, several definitions of MetSy have been proposed by various international organizations and expert groups by incorporating its different components. These include definitions by the National Cholesterol Education Program Adult Treatment Panel III (NCEP:ATPIII), American Association of Clinical Endocrinology (AACE), International Diabetes Federation (IDF), American Heart Association (AHA) in collaboration with National Heart, Lung and Blood Institute (NHLBI), and World Health Organization (WHO) [9]. A summary of these definitions is presented in Tables 1 and 2.
National Cholesterol Education Program Adult Treatment Panel III (NCEP:ATPIII): Any three or more of the following:
|
American Association of Clinical Endocrinology (AACE): Impaired glucose tolerance plus two or more of the following:
|
International Diabetes Federation (IDF): Central obesity (defined by waist circumference with ethnicity-specific values#, but can be assumed if BMI > 30 kg/m2), plus two of the following:
|
American Heart Association in collaboration with National Heart, Lung and Blood Institute (AHA/NHLBI): Any three of the following:
|
WHO clinical criteria for defining MetS:
|
Metabolic syndrome definitions [9].
Analyte | Range | Classification |
---|---|---|
Total Cholesterol1 (mmol/L) | < 5.2 | Desirable |
5.2–6.1 | Borderline high | |
> 6.1 | High | |
HDL1,2 (mmol/L) | > 1.53 | Less than average risk |
1.03–1.53 | Average risk (male) | |
1.29–1.53 | Average risk (female) | |
< 1.03 | Increased risk (male) | |
< 1.29 | Increased risk (female) | |
LDL1 (mmol/L) | < 2.6 | Optimal |
2.6–3.3 | Near optimal | |
3.4–4.1 | Borderline high | |
4.2–4.9 | High | |
> 4.9 | Very high | |
CHOL/HDL3,4 (mmol/L) | < 3.5 | Optimal (male) |
< 3.4 | Optimal (female) | |
> 5.0 | Above average risk (male) | |
> 4.4 | Above average risk (female) | |
VLDL55 | 0.1-1.7 | Normal / near optimal |
> 0.77 | High | |
Non-HDL1,2 (mmol/L) | < 3.4 | Optimal |
3.4–4.1 | Near optimal | |
4.2–4.9 | Borderline high | |
5.0–5.7 | High | |
> 5.7 | Very high | |
Triglycerides1 (mmol/L) | < 1.69 | Desirable |
1.69–2.25 | Borderline high | |
2.26–5.63 | High | |
> 5.63 | Very high | |
Glucose6,7,8 (mmol/L) | < 5.6 | Normal (fasting) |
< 7.8 | Normal (non-fasting) | |
4.1–6.6 | Reference interval (fasting) | |
< 2, > 30 | Critical |
Reference ranges for clinical and biochemical measurements.
National Cholesterol Education Program ATP III.
Lab Tests Online - Lipid Panel.
Harvard Medical Health Guide.
American Heart Association.
Lab Tests Online – VLDL.
Abaxis – Piccolo® Lipid Panel Plus Reagent Disc.
American Diabetes Association.
Mayo Clinic.
In an effort to provide more consistency in both clinical care and research of patients with MetSy, these various international organizations and expert groups published a consensus joint statement in 2009 on uniform diagnostic criteria, The Harmonized Definition of Metabolic Syndrome [10]. The Harmonized Definition of Metabolic Syndrome (MetSy) includes the presence of 3 of the 5 risk factors, these being enlarged waist circumference (WC) with population-specific and country-specific criteria (WC > 102 cm in men and WC > 88 cm in women), serum triglycerides ≥150 mg/dL or 1.69 mol/l, high density lipoprotein (HDL-c) < 40 mg/dL or 1.03 mmol/l in men and < 50 mg/dL or 1.29 mmol/l in women, systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 85 mm Hg, as well as fasting glucose ≥100 mg/dL or 5.6 mmol/l. Also included are patients taking medication to manage hypertriglyceridemia, low high-density lipoproteins (HDL-c), hypertension and hyperglycaemia.
MetSy predicts that the development of type 2 diabetes mellitus (T2DM) leads, in addition, to increased cardiovascular morbidity [9]. Thus, the main components of MetSy are: dyslipidaemia, characterized by elevated triglycerides and low High-Density Lipoproteins (HDL cholesterol), elevated blood pressure (BP), hyperglycaemia, abdominal obesity and/or insulin resistance (IR). Metabolic syndrome is not a disease per se, but a combination of metabolic abnormalities which can present in different ways in accordance with the various components that constitute the syndrome.
Many different factors such as genetics, lifestyle (diet and physical activity), obesity and insulin resistance have been hypothesized to play a role in the development of MetSy [8, 11, 12]. Visceral adiposity as a result of a high caloric intake has been demonstrated to be a primary trigger and a major causative factor for the pathogenesis in MetSy [13, 14, 15]. A metanalysis conducted by Ryckman et al. [16] found that the presence of a single element of metabolic syndrome could contribute to the development of metabolic syndrome, and that diabetes alone will later contribute to the development of hypertension. Obesity appears more common in females and this is attributed to the fact that most women gain weight outside the recommended levels during pregnancy [17].
Due to the aging population, global increase in obesity and sedentary lifestyles, the prevalence of MetSy is increasing throughout the world and it has become an epidemic of the 21st century [18]. Prevalence rates vary widely due to the criteria used, age of the population, gender, ethnic group, prevalence of obesity in the background population, and environment. The incidence of MetSY often parallels the incidence of obesity and incidence of T2DM. The global prevalence of MetSy has be estimated to be about one quarter of the World population [19]. The prevalence of MetSy is 0–50% or more in African populations, commoner in females and increases with age and urban housing (Okafor, 2012) [20].
Screening can include individuals with pre-symptomatic or unrecognized symptomatic disease [21]. Several studies have shown the importance of screening [22, 23, 24].
Health-screening programmes have been effectively used to pinpoint public-health challenges [25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40], and many countries have implemented nationwide health screening and intervention programmes that specifically target MetSy [41]. The first Framingham Risk Score is a gender-specific score that identifies patients at risk of developing cardiovascular complications within a 10-year period. It factors in age, sex, LDL cholesterol, HDL cholesterol, smoking, blood pressure and also whether the patient is on treatment or not for hypertension, lipidaemia and diabetes, and smoking [42]. Artigao-Rodenas et al. [42] applied the Framingham Risk Score in a prospective cohort study of four years in Spain and found that the model had a good predictive value, with negative predictive values in both sexes, a specificity of 85.6% in women and sensitivity of 79.1% in men in a population with high risk of cardiovascular disease. The model had a significant cumulative probability of individual survival by tertiles in both sexes with a p value <0.001.
BMI is currently the metric measure used to determine categories of bodyweight in adults (Table 3). Other methods and techniques of estimating body fat and body-fat distribution includes measurements of the waist circumference (WC), waist-hip ratio, underwater weighing, bioelectrical impedance analysis, skin-fold thickness and imaging techniques such as ultrasound, computed tomography, and magnetic resonance imaging with the later giving the most accurate estimates of body composition [44]. The problem of using MUAC is that there is no consensus on its cut-offs internationally [45]. Waist circumference has likewise been shown to estimate body fat, but is a fairly better guide to cardiometabolic disease risks as it identifies people with relatively low BMI but with increased intra-abdominal fat accumulation [46].
BMI (kg/m2) | Obesity Class | Disease Risk* (Relative to Normal Weight and Waist Circumference) | ||
---|---|---|---|---|
Men ≤40 in (≤.102 cm) Women ≤.35 in (≤.88 cm) | > 40 in (> 102 cm) > 35 in (> 88 cm) | |||
Underweight | < 18.5 | — | — | |
Normal† | 18.5–24.9 | — | — | |
Overweight | 25.0–29.9 | Increased | High | |
Obesity | 30.0–34.9 35.0–39.9 | I II | High Very High | Very High Very High |
Extreme Obesity | ≥.40 | III | Extremely High | Extremely High |
Body mass index and obesity [43].
Disease risk for type 2 diabetes, hypertension, and CVD.
Increased waist circumference can also be a marker for increased risk even in persons of normal weight.
In most studies which have measured estimated total body fat by a reference method, BMI was found not to be a strong predictor of body fat [47] and therefore other methods should be developed to better classify individuals at risk of developing MetSy [48]. This is important because there are established ethnic differences in the relationship between abdominal adiposity and metabolic disease risk [49, 50]. Baloyi and Mokwena [51] conducted a prospective cross-sectional study among the pregnant women attending antenatal care at Regional Hospital in Bloemfontein, South Africa in which they excluded BMI and WC in defining MetSy but considered the presence of 3 of the 5 risk factors based on the Harmonized Definition of Metabolic Syndrome. The prevalence of MetSy in this sample was 15.46% and the screening tool enables the screening of pregnant women for metabolic syndrome in all trimesters.
Adapted from “Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity.” WHO, Geneva, June 1997.
Studies have demonstrated that there are sex differences concerning risk factor predictors of MetSy, suggesting that levels of sex steroids hormones, estrogen/androgen, balance potentially play a vital role in determining MetSy [52, 53, 54, 55, 56]. In women, raised BMI, low HDL cholesterol, increased WC and hyperglycaemia were significantly greater contributors to the MetSy, whereas in men hypertension and elevated triglycerides were the main factors [55]. Case and Menendez [57] found two factors in SA that contributed to the gender prevalence disparity, nutritionally deprived during childhood and a higher socio-economic status than males. They identified women to have been nutritionally deprived during childhood; and having a higher socio-economic status. The contributing risk factors prevalent in women are abdominal obesity and insulin resistance, as well as physical inactivity, aging and polycystic ovarian syndrome in some [58]. Other factors contributing to the higher prevalence of MetSy in women is that women live longer than men, and it is reported that women develop cardiovascular disease (CVD) at an older age compared to men [59, 60]. There is a wide disparity in economic status among the black population compared to the other ethnic groups, and this correlates with the wide gap in the prevalence of obesity and disease between these ethnic groups that may be partly attributed to or mediated by these social inequalities [61].
There is an inverse relationship between socio-economic status and obesity in high-income countries but consistent positive association between obesity and socio-economic status in low- resource countries [62]. The transition towards Western lifestyle and urbanization which is accompanied by access to clean water and electricity, reduced housing density, more money available to spend on food, higher energy intake, commuting by taxi/vehicle and reduced physical activity or increased sedentary behavior have positively associated with obesity [56, 63]. The risk of developing specific components of MetSy such as obesity, hyperlipidaemia, hypertension, and elevated fasting blood sugar, has been largely attributed to environmental stressors including poor nutrition with consumption of high-calorie diets which are cheaper and fill the stomach at a cheaper price than healthy food, lack of exercise, and smoking [4]. There is a growing trends among the youths and young adult engaging in alcohol binge drinking, this conduct was found to be significantly associated with lower levels of high-density lipoprotein cholesterol (HDL-C). The low HDL-C increases the risk of developing cardiovascular diseases among these participants [64].
Available data support the theory of “developmental origins of adult disease” hypothesis, the “Barker Hypothesis”, which posits that a significant portion of the risk for adult metabolic conditions is determined by exposure occurring in the perinatal period [65]. The “Barker Hypothesis” proposes that a poor in-utero environment produced by maternal dietary or placental insufficiency may “program” susceptibility in the foetus to later development of cardiovascular and metabolic disease. The “Barker Hypothesis” further proposes that maternal MetSy has an epigenetic effect, making the next generation unwell and leading to an increase in T2DM and cardiovascular disease in juvenile age and in later life from obesity [65, 66]. The MetSy is further associated with polycystic ovary syndrome in girls, obstructive sleep apnoea, hypogonadism and some form of gynecological cancers especially endometrial cancer [67].
Under normal conditions in both males and females, gonadotropin-releasing hormone is produced and released from the hypothalamus, which stimulates the production and release of the gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. FSH and LH act on the respective gonads, testicles in men and ovaries in women, to stimulate spermatogenesis and steroidogenesis, and folliculogenesis and steroidogenesis respectively [68].
In both sexes, LH stimulates secretion of sex steroids from the gonads. In the testes, LH binds to receptors on Leydig cells, stimulating synthesis and secretion of testosterone. Theca cells in the ovary respond to LH stimulation by secretion of testosterone, which is converted into estrogen by adjacent granulosa cells. In females, the LH surge leads to ovulation of mature follicles on the ovary and later to form corpus luteum, which secrete the steroid hormones progesterone and oestradiol. In the event of pregnancy progesterone is necessary for the maintenance of that pregnancy.
The FSH is responsible for the maturation of ovarian follicles. Administration of FSH to humans and animals induces “superovulation”, an increased number of mature gametes. FSH is also critical for spermatogenesis and sperm cell maturation at the Sertoli cells.
LH and FSH secretion is under the influence of gonadotropin-releasing hormone (GnRH, also known as LH-releasing hormone). GnRH is a ten amino acid peptide that is synthesized and secreted from hypothalamic neurons and binds to receptors on gonadotrophs.
As depicted in Figure 1 below, GnRH stimulates secretion of LH, which in turn stimulates gonadal secretion of the sex steroids testosterone, estrogen and progesterone. In a classical negative feedback loop sex steroids(oestrogens, progesterone, testosterone) inhibit secretion of GnRH and also appear to have direct negative effects on gonadotrophs.
(
This regulatory loop leads to pulsatile secretion of LH and, to a much lesser extent, FSH. The number of pulses of GnRH and LH varies from a few per day to one or more per hour. In females, pulse frequency is clearly related to stage of the cycle.
Several hormonal substances such as inhibin and activin from the gonads, which selectively inhibit and activate FSH secretion from the pituitary, influence GnRH secretion, and positive and negative control over GnRH [69]. Thus gonadotropin secretion is actually considerably more complex than depicted in Figure 1 below.
Obesity is a cardinal feature of MetSy and has been increasing in [70]. The effect of obesity on reproduction and as a cause of female infertility has been more extensively studied in females [70]. Obesity has been recently associated with an increased incidence of male factor infertility. A study from Norway looked at planned pregnancies and the time to achieving pregnancy, after adjusting for female BMI and smoking habits, the results showed that overweight and obese men had an odds ratio of infertility of 1.19 and 1.36, respectively [71]. Ramlau-hansen et al. [72] conducted a similar study comprising nearly 48,000 couples for six years assessing the effects of both male and female obesity on infertility and found that overweight and obese men coupled with normal- weight females had an odds ratio for reduced fertility of 1.18 and 1.53, respectively. A further observation was that couples where both parents were overweight or obese, the odds ratios for reduced fertility were 1.41 and 2.74, respectively [73]. Obese people have decreased gonadotropin levels, and increased circulating estrogen levels [74]. The increase in estrogen is likely secondary to peripheral aromatization of androgens from cholesterol in the adipose tissue. A hypogonadotropic hypogonadism state is created due to estrogen negative feedback onto the hypothalamus [74].
Metabolic disorders, including diabetes, obesity, and hyperlipidaemia plays a significant role in the development of female-specific reproductive health issues, which have a significant impact on public health. MetSy also increases the risk of reproductive cancers such as, breast, endometrial, bladder and cervical cancers [73]. Obesity particularly impacts women of reproductive age, as it is associated with an increased risk of infertility and adverse obstetric outcome such as miscarriage, stillbirth, birth defects and cesarean section [70, 75, 76]. MetSy can affect women’s reproductive health and fertility directly or indirectly by interfering with the hypothalamic – pituitary – gonadal (HPG) axis function. MetSy creates conditions of negative energy balance and metabolic stress which cause hypogonadism by suppressing the expression of the hypothalamic KiSS/kisspeptin [77, 78].
In addition to the effect of peripheral aromatization which create the hypogonadotropic hypogonadism state in obese women, a lack of residual insulin secretion in diabetes is also associated with the status quo [79]. The hypothalamic origin of the decreased levels of gonadotropin in amenorrhoeic and diabetic patients are related to a toxic effect of hyperglycaemia on the neurons of the hypothalamus leading to reduced LH response to GnRH stimuli [80].
Adrenarche is the puberty of the adrenal gland. Pubarche is denoted by the appearance of pubic hair and or axillary hair. Premature adrenarche in girls is when pubarche occurs before age 8 years in girls and 9 years in boys. The chief hormonal products of adrenarche are DHEA and DHEAS produced from zona reticularis. Premature adrenarche represents an early clinical feature of MetSy (obesity, hypertension, dyslipidaemia, insulin resistance) for some girls. Conceivably the early recognition of these children will permit allow early intervention, such as lifestyle modifications, including dietary, activity level intervention with possibility of using insulin-sensitizing agents in some individuals. Premature pubarche due to premature adrenarche and hyperinsulinemia may precede the development of ovarian hyperandrogenism [81].
Interference with the hypothalamic – pituitary – gonadal axis function may affect follicular recruitment and impact subsequent oocyte quality and affecting overall subfertility in obese women. Studies of women undergoing assisted reproductive technologies (ART) have demonstrated that obesity also has direct effects on the quality oocytes and embryos and on the status of the endometrium. Audit data from retrospective studies demonstrated obesity to be associated with increased risk for miscarriage in spontaneous conceptions [82] as well in pregnancy achieved through donor oocytes after IVF [83]. The pathophysiology underlying this association is complex and likely multifactorial, involving the oocyte, embryonic development, and the endometrium. Apart from fertility and pregnancy problems, female adiposity may influence the timing of onset of puberty, associated with irregular menses, ovulatory dysfunction and ovarian aging [77].
Polycystic ovary syndrome (PCOS) is a hormonal disorder common, among women of reproductive age affecting 5 to 10 percent, often complicated by chronic anovulatory infertility and hyperandrogenism with the clinical manifestations of oligomenorrhoea, hirsutism and acne [84, 85]. The link between PCOS and obesity is complicated. Signs and symptoms of polycystic ovarian syndrome begin for some females soon after menarche. Women with PCOS have insulin resistance (IR) [86]. This insulin resistance is one reason why women with PCOS tend to gain weight or experiences challenges in losing weight. In some females, PCOS develops later on, following substantial weight gain. Women affected by obesity are also more likely to face reproductive problems like polycystic ovarian syndrome (PCOS) and women with PCOS have a greater risk for obesity. Obesity and PCOS share some common features, anovulation and hyperandrogenism although simple or non-syndromic obesity is much more prevalent than PCOS and seems to have a different pathophysiology with respect to the obesity-related reproductive impairment [87]. The difference in the two is that PCOS is characterized by increased serum LH whereas obese women typically have in general lower serum LH. Obesity may modify some aspects hypothalamic – pituitary – gonadal axis function [88]. Although obesity can affect many facet of PCOS, it is a cause of this syndrome and without doubt have an effect on reproduction regardless of PCOS symptomatology [87]. In this review, we will focus on how obesity in the absence of PCOS affects the HPO axis.
Obesity, as a cardinal feature of MetS, has been associated with an increased incidence of male factor infertility. Although the effect of excess body fat on reproduction has been more extensively studied in females, there has been a recent increase in literature assessing the relationship between obesity and semen characteristics, male endocrine changes, male sexual function and male factor infertility. Over the past decade, numerous studies have found an inverse correlation between increased obesity and semen quality that negatively affects male fertility, with an increased chance of subfertility among couples in which the male partner is obese. Various mechanisms for this relationship have been proposed and can be broadly divided into direct negative effects on spermatogenesis and sperm function (lower sperm counts, poorer sperm quality), hormonal factors and, and increased rates of erectile dysfunction [89, 90]. In males, a state of primary hypogonadism is also well defined as an underlying feature associated with MetS [89].
Obesity in men contribute to the poor reproductive function through numerous postulated mechanisms. First, hormonal perturbations that involves peripheral conversion of testosterone to estrogen in excess peripheral adipose tissue may lead to secondary hypogonadism through HPG axis inhibition. Second, elevated levels of inflammatory mediators and reactive oxygen species (ROS), generating oxidative stress at the level of the testicular micro environment may result in decreased spermatogenesis and sperm DNA fragmentation. Lastly, the accumulation of supra pubic and inner thigh fat may result in increased testicular heat, which cumulatively can have substantial, detrimental effects on spermatogenesis [74, 90, 91, 92].
Men with obesity, the metabolic syndrome and type 2 diabetes have low total and free testosterone and low sex hormone-binding globulin SHBG. On the other hand, the presence of low testosterone and/or SHBG predicts the future development of metabolic syndrome and T2DM [93]. Thus, the observed decrease in testosterone levels in obese males is likely due to several factors, including decreased synthesis of testosterone, inhibition of SHBG synthesis, and decreased gonadotropin secretion [93]. In summary, total testosterone, free testosterone and SHBG are all commonly decreased in obese males. Obesity is also characterized by higher insulin levels and insulin resistance this is suggested to impair steroidogenesis at the Leydig cells which may negatively impact the male reproductive function in the case of obesity [94, 95]. Derby et al. [96] conducted a longitudinal trial of 942 men ages 40–70 years enrolled in the Massachusetts Male Aging Study, demonstrated that BMI was negatively associated with total testosterone, free testosterone, and SHBG, as well as that these levels decline more rapidly with age in obese men.
Adipose tissue behaves like an endocrine gland, it produces hormonally active proteins involved in satiety and metabolism as well as HPG axis regulation [97]. The white adipose tissue produces leptin [74, 97] which has been found to stimulate gonadotropin-releasing hormone secretion in the hypothalamus and FSH and LH secretion in the anterior pituitary in the rat animal studies [98, 99]. Leptin is also believed to have a direct effect on regulation of testosterone production in the testicle taking into account the presence of leptin receptors in Leydig cells [100]. Obesity generates a leptin resistant state, given that high circulating leptin levels are linked with increased adiposity and lower testosterone levels [101].
Obesity creates a proinflammatory state with production of adipokines and cytokines by adiopocytes that result in an increase in systemic inflammation [102] Any form of Inflammation of the reproductive tract has been shown to be associated with infertility in male patients. The cytokines tumor necrosis factor (TNF-a) and interleukin-1(IL-1) have been implicated as the main mediators of the inflammatory process [103]. Inflammation increases levels of reactive oxygen species generating oxidative stress at the level of the testicular that can negatively impact normal reproductive pathways [104]. Elevated oxidative stress leads to increased DNA damage of spermatozoa and is negatively correlated with normal sperm morphology [105, 106, 107]. Tunc et al. [108] compared reactive oxygen levels in semen samples from both overweight/obese men and men of normal BMI and found that there was a weak but statistically significant positive correlation between increasing BMI and reactive oxygen species levels.
Spermatogenesis is also adversely effected by elevated testicular temperature. Increased adiposity in the legs and pannus overlying the scrotum may lead to increased testicular temperatures. Shafik and Olfat [109] performed lipectomy to remove the excess scrotal lipoma from a series of infertile men and later observed improvements in their semen parameters in 64.7% of study participants and pregnancies in 19.6% [109]. Prolonged inactivity in obese men has also been associated with increased scrotal temperatures [110].
Health promotion is ‘the process of enabling people to increase control over and to improve their health’ Introduced into public health in Ottawa in 1986 [111]. Health promotion strategies can be achieved by developing and changing lifestyles, to impact on the social, economic and environmental conditions that determine health.
The Ottawa Charter for Health Promotion set out five strategies that are essential for the success for any health promotion strategy: Build healthy policy; Create supportive environments; Strengthen community actions; Develop personal skills; and Reorient health services. Health promotion actions should target the population at risk, early in life to stop the metabolic storm, by increasing their knowledge and warning them about the dangers of MetSy, enforcing bans on alcohol and tobacco advertising, promotion and sponsorship, raising taxes on alcohol and tobacco and reducing the price of healthy diet food. It is of vital importance to note that the ideal time for intervention is pre-conception. Health-care workers who attend to women of reproductive age and diagnose obesity, have a duty to counsel and refer these patients to high-risk obstetric specialists for consultation to discuss the many risks associated with obesity in pregnancy [112].
These obese patients should be encouraged strongly to undertake nonsurgical interventions to achieve weight reduction to achieve ideal body weight (BMI, 18.5–24.9 kg/m2) before conception. These include, among others, behavioral modification, dietary changes, exercise, and pharmacotherapy [113]. Dietician consultation is recommended for diet advice that is high in fiber, fresh fruit, vegetables, lean protein, and complex carbohydrates, while avoiding foods that contain large amounts of sugar, saturated fats, and cholesterol. Regular fitness exercises based on available facilities such as brisk walking, stair climbing, jogging, or swimming that use the larger skeletal muscles should be incorporated into weight reduction programs. Once the diagnosis of MetSy in Pregnancy or elements of it is made, it’s possible to provide intervention to prevent progression of the condition and complications in pregnancy and the associated adverse perinatal outcomes [114].
Insulin resistance and central obesity are regarded as the main underlying causes of metabolic syndrome. Therefore, reduction in body weight will lead to fatty acid mobilization and should be the key focus in management of the MetSy [115]. Stinson et al. [116] showed that overconsumption of poor diet is an important component of the MetSy, and thus needs to be targeted for its reduction and treatment. A literature review on randomized control trials has shown improvement in MetSy following intervention focusing on diet and lifestyle modification, either in certain components or taken as a whole syndrome within a period of 2 weeks–1 year [117]. Informing and educating the public should include nutrition, promotion of regular physical activity, reduction of substance abuse as well as prevention or management of central adiposity, diabetes, atheromatosis and hypertension, and setting a national agenda to motivate all population groups to change stereotype perceptions and behaviors aimed at health and quality-of-life promotion.
Literature provides evidence of efficacy in adhering to the Mediterranean diet (MeD) in reducing body weight [118]. The Mediterranean Dietary pattern is comprised of fruit, cooked vegetables and legumes, grains (whole, not refined) and, in moderation, wine, nuts, fish and dairy products, particularly yogurt and cheese. It is a food pattern that has the potential of improving health and quality of life in people who adhere to it appropriately, characterizing a way of life and culture [119]. These interventions to alter diet and lifestyle have the potential to succeed only if they are executed early, and thus, offer enough evidence to develop appropriate public policies.
Obese women with overtly high BMI of more than 40 kg/m2 or BMI of 35 kg/m2 with the presence of comorbid NCD conditions (such as diabetes mellitus, coronary artery disease, or severe sleep apnea), should be referred to a specialist surgeon for possible bariatric surgery [120]. Great success has been reported with women who have undergone Bariatric surgery followed by healthy lifestyle modifications [121], by generally demonstrating overall recovery in quality-of-life measures and resolution of their medical comorbidities [122, 123].
Patients who have undergone bariatric surgery should be counseled to avoid pregnancy for a period of 12–18 months after the procedure. Falling pregnant during this interval has been associated with higher risk of surgical complications and exposure of the foetus to rapid weight change [124].
MetSy is not only as a predictor of cardiovascular disease but also as a potential contributing factor to poor reproductive health and interfere with fertility in both male and female affected across her lifespan. Perhaps the most concerning information presented in this chapter is the Barker hypothesis, that the metabolic syndrome’s adverse effects are likely transgenerational where children born to obese mothers are at increased risk for obesity, diabetes and cardiovascular disease later in life. There is also increasing and worrying evidence that lifestyle factors such as alcohol binge consumption increases the incidence of metabolic syndrome. Obesity exerts it detrimental effect in the human body by generating a physiological resistant state in the such as a leptin resistant state, insulin resistant.
Noncommunicable disease is rising globally at an alarming rate, future studies focus should be on the strategies needed to improve public health programs and policies aimed at reducing the prevalence of metabolic syndrome through screening at all contacts for all types of patients to save the future generations. Instituting early and targeted lifestyle interventions such as balanced diet and frequent physical activity for metabolic syndrome is a medical exigency.
The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the review.
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\\n\\nThe Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
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\\n\\nThe University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\\n\\nThe University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\\n\\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
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\n\nCSIC affiliated authors can also take advantage of a central Open Access fund (amounting to 10,000 EUR) to cover up to 50% of the rest of the OAPF until it expires. Effective for chapters accepted from January 1, 2020.
\n\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
\n\n\n\nCorresponding authors will receive a 25% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters. A 20% discount for publishing a long-form monographs, 25% for compacts and 23% for short-form monographs.
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\n\nThe Claremont Colleges are pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\nCorresponding authors will receive a 15% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\nThe University of Massachusetts, Amherst is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\nThe University of Surrey is pledging funds via the Knowledge Unlatched program to ensure academics can publish Open Access content more easily.
\n\nCorresponding authors will receive a 10% discount on their Open Access Publication Fees (OAPF) for Open Access book chapters or monograph publications. To use the discount you will need to verify your institutional email address. These discounts are valid from 2020 to 2022.
\n\nMonographs Only
\n\n\n\nImportant: You must be a member or grantee of the above listed institutions in order to apply for their Open Access publication funds.
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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. 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Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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