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Cited by 294Diabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Function and Risk FactorsChronic Disease Management Strategies

The CardioMetabolic Health Alliance

Open access
Sperling, Laurence S., Mechanick, Jeffrey I., Neeland, Ian J., Herrick, Cynthia J., Després, Jean-Pierre, Ndumele, Chiadi E., Vijayaraghavan, Krishnaswami, Handelsman, Yehuda +18 more·2015·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2015.06.1328
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Abstract

The Cardiometabolic Think Tank was convened on June 20, 2014, in Washington, DC, as a "call to action" activity focused on defining new patient care models and approaches to address contemporary issues of cardiometabolic risk and disease. Individual experts representing >20 professional organizations participated in this roundtable discussion. The Think Tank consensus was that the metabolic syndrome (MetS) is a complex pathophysiological state comprised of a cluster of clinically measured and typically unmeasured risk factors, is progressive in its course, and is associated with serious and extensive comorbidity, but tends to be clinically under-recognized. The ideal patient care model for MetS must accurately identify those at risk before MetS develops and must recognize subtypes and stages of MetS to more effectively direct prevention and therapies. This new MetS care model introduces both affirmed and emerging concepts that will require consensus development, validation, and optimization in the future.

Integrity signals

Registry

Crossref · 10.1016/j.jacc.2015.06.1328

Cites

106 of 106 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 81 cited sources checked · 0 supported · 0 flagged

  • Interpretationcitation

    Lifestyle, referring to physical activity and nutrition, is a modifiable factor crucial to prevent and treat MetS and its consequences.

    “The TT recognized lifestyle, referring to physical activity and nutrition, as being a modifiable factor crucial to prevent and treat MetS and its consequences.”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    The current definition of MetS does not account for susceptibility for a given degree of adiposity.

    “nor does it account for susceptibility for a given degree of adiposity, as noted earlier.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Waist circumference appeared to be a better predictor of total body fat than BMI.

    “waist circumference appeared to be a better predictor of total body fat than BMI (18).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Vega, 2006, Influence of body fat content and distribution on variation in metabolic risk, J Clin Endocrinol Metab source

      Not checked in the free run.

  • Premisecitation

    Excess truncal fat further increased risk after adjusting for total body fat.

    “Excess truncal fat further increased risk after adjusting for total body fat.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Vega, 2006, Influence of body fat content and distribution on variation in metabolic risk, J Clin Endocrinol Metab source

      Not checked in the free run.

  • Premisecitation

    Malay women with MetS had different factor patterns with greater importance of hypertension, insulin resistance, and triglycerides when compared with other South Asian women.

    “For example, Malay women with MetS had different factor patterns with greater importance of hypertension, insulin resistance, and triglycerides when compared with other South Asian women (7).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Ang, 2005, The metabolic syndrome in Chinese, Malays, and Asian Indians. Factor analysis of data from the 1998 Singapore National Health Survey, Diabetes Res Clin Pract

      Not checked in the free run.

  • May combine two claims. 39
  • Classified as probably not a substantial claim. 20
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    Factor analysis in epidemiological studies in different populations, including adolescents and ethnic minorities, demonstrates clustering of risk in the domains of adiposity and/or dyslipidemia, hyperglycemia or insulin resistance, and hypertension that explain 37% to 70% of variation and vary by sex and race.

    “Factor analysis in epidemiological studies in different populations, including adolescents and ethnic minorities, demonstrates clustering of risk in the domains of adiposity and/or dyslipidemia, hyperglycemia or insulin resistance, and hypertension that explain 37% to 70% of variation and vary by sex and race (4-7).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [4] Goodman, 2005, Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth, Circulation source

      Not checked in the free run.

    • cites [5] Hanley, 2002, Factor analysis of metabolic syndrome using directly measured insulin sensitivity: The Insulin Resistance Atherosclerosis Study, Diabetes source

      Not checked in the free run.

    • cites [6] Hodge, 2001, Leptin and other components of the Metabolic Syndrome in Mauritius—a factor analysis, Int J Obes Relat Metab Disord source

      Not checked in the free run.

    • cites [7] Ang, 2005, The metabolic syndrome in Chinese, Malays, and Asian Indians. Factor analysis of data from the 1998 Singapore National Health Survey, Diabetes Res Clin Pract

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Metabolic syndrome (MetS) is a complex pathophysiological state comprising a cluster of clinically measured and typically unmeasured risk factors.

    “The Think Tank consensus was that the metabolic syndrome (MetS) is a complex pathophysiological state comprised of a cluster of clinically measured and typically unmeasured risk factors”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Risk for adverse health outcomes increases substantially with accumulation of component MetS risk factors, in addition to unmeasured residual risk factors.

    “AC.3.Risk for adverse health outcomes increases substantially with accumulation of component MetS risk factors, in addition to unmeasured (”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    People with MetS have or are at risk for multi-end-organ damage.

    “Another concept essential to the MetS definition is that people with MetS have or are at risk for multi-end-organ damage.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Obesity per se, as defined by simple anthropometric measures such as BMI or waist circumference, is neither a necessary nor a sufficient descriptor of MetS and its consequences.

    “However, there is a growing appreciation that obesity per se, as defined by simple anthropometric measures, such as BMI or waist circumference, is neither a necessary nor a sufficient descriptor of MetS and its consequences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    MetS is present in approximately 50% of patients with diagnosed vascular disease and may be even more prevalent among women with ASCVD.

    “MetS is present in w50% of patients with diagnosed vascular disease and may be even more prevalent among women with ASCVD (10,11).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Gorter, 2004, Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm, Atherosclerosis source

      Not checked in the free run.

    • cites [11] Brevetti, 2006, Metabolic syndrome in peripheral arterial disease: relationship with severity of peripheral circulatory insufficiency, inflammatory status, and cardiovascular comorbidity, J Vasc Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The latest prevalence estimates of MetS in men and women are 35% and 33%, respectively.

    “The latest prevalence estimates of MetS in men and women are 35% and 33%, respectively (42).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Go, 2014, Heart disease and stroke statistics—2014 update: a report from the American Heart Association, Circulation

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Excess ectopic and/or visceral adiposity is fundamental to the pathophysiology of MetS.

    “Excess ectopic and/or visceral adiposity is fundamental to the pathophysiology of MetS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the Framingham Offspring Study, both MetS and T2D increased the risk of stroke by approximately 2-fold, and those patients with both had an even higher risk.

    “In the Framingham Offspring Study, both MetS and T2D increased the risk of stroke by approximately 2-fold, and those patients with both had an even higher risk (12).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Najarian, 2006, Metabolic syndrome compared with type 2 diabetes mellitus as a risk factor for stroke: the Framingham Offspring study, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Filipina women may have higher waist circumference and truncal fat and 3- to 4-fold higher rates of type 2 diabetes (T2D) and MetS compared with Caucasian women, controlling for other factors.

    “Similarly, Filipina women may have higher waist circumference and truncal fat and 3-to 4-fold higher rates of type 2 diabetes (T2D) and MetS compared with Caucasian women, controlling for other factors (17).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Araneta, 2002, Type 2 diabetes and metabolic syndrome in Filipina-American women, Diabetes Care source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Because forecasts suggest that over one-half of the U.S. population will be obese by the year 2030, rates of MetS will almost certainly increase over the next decade.

    “Because forecasts suggest that over one-half of the U.S. population will be obese by the year 2030, rates of MetS will almost certainly increase over the next decade.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    MetS is associated with serious and extensive comorbidity.

    “is associated with serious and extensive comorbidity”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Obesity is a MetS risk factor that is imperfectly gauged by body mass index and/or waist circumference, and is modulated by adipocyte distribution, size, and function, as well as race, behavior, and lifestyle.

    “AC.4.Obesity is a MetS risk factor that is imperfectly gauged by body mass index and/or waist circumference, and is modulated by adipocyte distribution, size, and function, as well as race, behavior, and lifestyle.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    MetS is a progressive pathophysiological state associated with substantially increased risk for development of type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD).

    “AC.1.Metabolic syndrome (MetS) is a progressive pathophysiological state associated with substantially increased risk for development of type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    MetS is clinically manifested by a cluster of risk factors that are causally inter-related, not aggregating by chance alone.

    “AC.2.MetS is clinically manifested by a cluster of risk factors that are causally inter-related (not aggregating by chance alone).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The current definition of MetS identifies a population at increased ASCVD risk.

    “First, the current definition of MetS identifies a population at increased ASCVD risk”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    MetS is progressive in its course.

    “is progressive in its course”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    South Asians have higher body fat content, waist to hip ratio, visceral fat to subcutaneous fat ratio, and adipocyte area than Caucasians matched for age, sex, and body mass index (BMI).

    “For example, South Asians have higher body fat content, waist to hip ratio, visceral fat to subcutaneous fat ratio, and adipocyte area than Caucasians matched for age, sex, and body mass index (BMI) (15,16).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Anand, 2011, Adipocyte hypertrophy, fatty liver, and metabolic risk factors in South Asians: The Molecular Study of Health and Risk in Ethnic Groups (mol-SHARE), PLOS One source

      Not checked in the free run.

    • cites [16] Chandalia, 2007, Insulin resistance and body fat distribution in South Asian men compared to Caucasian men, PLOS One source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    The TT identified disparity in care of patients with MetS to be a critical area for improvement.

    “The TT identified disparity in care of patients with MetS to be a critical area for improvement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The Healthy Living Partnerships to Prevent Diabetes Study, a DPP-like lifestyle weight-loss program over 2 years using community health workers, found that among 301 randomized patients, the intervention group achieved significant reductions in weight, BMI, waist circumference, glucose, insulin, and HOMA-IR compared with control subjects, with 46.5% achieving ≥5% weight loss and 21.3% achieving ≥

    “The Healthy Living Partnerships to Prevent Diabetes Study implemented a DPP-like lifestyle weight-loss program over 2 years by using a local diabetes education program with community health workers, involving weekly visits over the first 6 months and twice monthly visits over the next 18 months (83).Among 301 randomized patients, the intervention group achieved significant reductions in weight, B”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Katula, 2013, The Healthy Living Partnerships to Prevent Diabetes study: 2-year outcomes of a randomized controlled trial, Am J Prev Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Medicare beneficiaries in the same market as a commercial ACO realized decreases in total health care spending over 2 years, primarily due to reduced outpatient office visits, minor procedures, imaging, and laboratories.

    “Medicare beneficiaries in the same market as a commercial ACO realized decreases in total health care spending over 2 years, primarily due to reduced outpatient office visits, minor procedures, imaging, and laboratories.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [103] McWilliams, 2013, Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Larger provider groups attenuated racial disparities in some areas, but did not change disparities on other metrics, such as hospitalization rates.

    “Although larger provider groups attenuated racial disparities in some areas, they did not change disparities on other metrics, such as hospitalization rates (107).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [107] Anderson, 2014, Quality of care and racial disparities in Medicare among potential ACOs, J Gen Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An extension study of DEPLOY found that both control and intervention arms maintained weight changes compared with baseline, and those in the initial intervention group lost a further 1.5% of body weight, with significant decreases in total cholesterol and systolic blood pressure.

    “An extension study in which both the control and intervention arms were offered an 8-month lifestyle maintenance program found that both groups maintained weight changes compared with baseline, and those in the initial intervention group lost a further 1.5% of body weight, with significant decreases in total cholesterol and systolic blood pressure (79).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] Ackermann, 2011, Long-term effects of a community-based lifestyle intervention to prevent type 2 diabetes: the DEPLOY extension pilot study, Chronic Illn source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A randomized controlled trial in 2 community health centers enrolled 525 patients with uncontrolled ASCVD, T2D, hypertension, or hyperlipidemia; results showed that pairing nurse practitioners and community health workers demonstrated significant reductions in blood pressure, cholesterol, and HbA1c over 1 year of follow-up compared with usual care.

    “A randomized controlled trial in 2 community health centers enrolled 525 patients with uncontrolled ASCVD, T2D, hypertension, or hyperlipidemia; results showed that pairing nurse practitioners and community health workers demonstrated significant reductions in blood pressure, cholesterol, and HbA 1c over 1 year of follow-up compared with usual care (86).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [86] Allen, 2011, Community Outreach and Cardiovascular Health (COACH) trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers, Circ Cardiovasc Qual Outcomes source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S2 (checkable). May combine two claims.

    Interpretationnone given

    Well-intentioned alteration of existing diagnostic criteria around racial differences could stigmatize minority populations and lead to undesirable consequences.

    “In addition to this and other race-specific issues, however, TT participants recognized that wellintentioned alteration of existing diagnostic criteria around racial differences could stigmatize minority populations and lead to undesirable consequences.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The TT acknowledges that the concepts of staging and subtyping are works in progress and require further modification, testing, and validation before they can be used routinely in clinical care.

    “The TT acknowledges that the concepts of staging and subtyping are works in progress and require further modification, testing, and validation before they can be used routinely in clinical care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The Look AHEAD trial provides the longest-term evidence of the effect of an intensive lifestyle intervention in overweight and obese adults with T2D; at 8 years, 50.3% in the intervention group versus 35.7% in the usual care group lost ≥5% of body weight, and 26.9% versus 17.2% lost ≥10% of body weight.

    “The Look AHEAD (Action for Health in Diabetes) trial provides the longest-term evidence of the effect of an intensive lifestyle intervention in overweight and obese adults with T2D.The curriculum was modified from the DPP and included structured meal plans and moderate exercise up to 200 min/week.At 8 years, 50.3% in the intervention group versus 35.7% in the usual care group lost $5% of body”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [84] 2014, Eight-year weight losses with an intensive lifestyle intervention: the Look AHEAD Study, Obesity (Silver Spring) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Several dietary patterns, such as the DASH and Mediterranean diets, may reduce blood pressure, improve lipids, reduce inflammation, and reduce risk for ASCVD.

    “Several dietary patterns, such as the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets, may reduce blood pressure, improve lipids, reduce inflammation, and reduce risk for ASCVD (28,70).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [28] Eckel, 2014, 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [70] Estruch, 2013, Primary prevention of cardiovascular disease with a Mediterranean diet, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    On average, African-Americans have higher HDL-C and lower triglyceride levels.

    “On average, African-Americans have higher HDL-C and lower triglyceride levels(72).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72] Frank, 2014, Racial/ethnic differences in dyslipidemia patterns, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Group Health Cooperative reduced physician panel sizes, increased ancillary staff, lengthened visit times, and provided time for team care planning, in addition to expanding technology to better engage patients; comparison with control clinics demonstrated better patient satisfaction scores, reduced provider burnout, improved performance on quality of care metrics, and reduced emergency

    “The Group Health Cooperative reduced physician panel sizes, increased ancillary staff, lengthened visit times, and provided time for team care planning, in addition to expanding technology to better engage patients.Comparison with control clinics in the area demonstrated better patient satisfaction scores, reduced provider burnout, improved performance on quality of care metrics, and reduced”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [97] Reid, 2010, The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers, Health Aff (Millwood) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Geisinger ProvenHealth Navigator demonstrated a reduction in the incidence of end-stage renal disease and amputation among patients with T2D over 4 years, although without a change in myocardial infarction or stroke.

    “For example, the Geisinger ProvenHealth Navigator demonstrated a reduction in the incidence of end-stage renal disease and amputation among patients with T2D over 4 years, although without a change in myocardial infarction or stroke (98).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [98] Maeng, 2012, Can a patient-centered medical home lead to better patient outcomes? The quality implications of Geisinger's ProvenHealth Navigator, Am J Med Qual source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Higher levels of physical activity are associated with lower rates of chronic diseases and increased longevity.

    “Many observational studies show an association between higher levels of physical activity and lower rates of chronic diseases and increased longevity (67).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Warburton, 2010, A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults, Int J Behav Nutr Phys Act source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    Current definitions of abdominal obesity are imprecise and not well suited for many populations.

    “Second, participants felt that better metrics are needed to define abdominal obesity, as current definitions are imprecise and not well suited for many populations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The presence of ectopic fat and/or visceral adipose tissue is critical to the pathogenesis of MetS and may explain some of the variability in phenotypic presentation across racial groups.

    “KF.2.The presence of ectopic fat and/or visceral adipose tissue is critical to the pathogenesis of MetS and may explain some of the variability in phenotypic presentation across racial groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Evaluation of a PCMH model in West Virginia found that an EHR-based screening tool identified 11% of over 94,000 patients as being at risk for T2D, enabling the facility to better screen and connect patients to local lifestyle intervention programs.

    “Evaluation of another such model in West Virginia found that an EHR-based screening tool identified 11% of over 94,000 patients as being at risk for T2D (99), enabling the facility to better screen and connect patients to local lifestyle intervention programs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [99] Baus, 2013, Registry-based diabetes risk detection schema for the systematic identification of patients at risk for diabetes in West Virginia primary care centers, Perspect Health Inf Manag

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The paradox of higher HDL-C and lower triglycerides in African-Americans may translate to underdiagnosis of MetS in African-Americans using current diagnostic criteria, which would likely result in lack of treatment of MetS in this population.

    “This paradox may translate to underdiagnosis of MetS in African-Americans using current diagnostic criteria, which would likely result in lack of treatment of MetS in this population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A program targeting a predominantly low-income non-Caucasian urban population delivered a lifestyle intervention in 12 weeks using group sessions and found significant reductions in the proportion of subjects meeting the MetS waist circumference (90% to 68%; p=0.009) and hypertension (68% to 48%; p=0.04) criteria over 6 months; at 3 months, 46.4% lost ≥5% of body weight and 26% lost ≥7% of body

    “A program targeting a predominantly low-income non-Caucasian urban population delivered a lifestyle intervention in 12 weeks using group sessions and found significant reductions in the proportion of subjects meeting the MetS waist circumference (90% to 68%; p ¼ 0.009) and hypertension (68% to 48%; p ¼ 0.04) criteria over 6 months.At 3 months, 46.4% lost $5% of body weight and 26% lost $7% of body”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [91] Seidel, 2008, Translating the Diabetes Prevention Program into an urban medically underserved community: a non-randomized prospective intervention study, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study of 36 family practices implementing PCMH components over 26 months, improvement was seen in prevention and chronic care quality metrics, but not in patient-assessed outcomes.

    “In another study of 36 family practices implementing PCMH components over 26 months, improvement was seen in prevention and chronic care quality metrics, but not in patient-assessed outcomes (96).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] Jaén, 2010, Patient outcomes at 26 months in the patient-centered medical home National Demonstration Project, Ann Fam Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    MetS is a cluster of risk factors, both formally defined and less well recognized, that increase the risk of certain diseases.

    “KF.1.MetS is a cluster of risk factors, both formally defined and less well recognized, that increase the risk of certain diseases.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    The DEPLOY study, a pilot cluster-randomized trial comparing group-based DPP lifestyle intervention through a YMCA with brief counseling, found that among 92 randomized participants, at both 4 to 6 and 12 to 14 months, the percent change in weight and BMI, as well as the change in total cholesterol, was significantly greater in the intervention group.

    “The DEPLOY (Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA) study was a pilot clusterrandomized trial comparing group-based DPP lifestyle intervention through a Young Men's Christian Association (16 group sessions with goals of 5% to 7% reduction in baseline body weight and 150 min/ week of moderate exercise) with brief counseling.Among 92 randomized participants”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [78] Ackermann, 2008, Translating the Diabetes Prevention Program in the community. The Deploy Pilot Study, Am J Prev Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although different financial models have been proposed and are incorporated in some PCMH models, evaluations do not specifically address the effectiveness of these strategies, nor have most studies demonstrated overall short-term cost savings.

    “Although different financial models have been proposed and are incorporated in some PCMH models, evaluations do not specifically address the effectiveness of these strategies, nor have most studies demonstrated overall short-term cost savings (100).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [100] Edwards, 2014, Structuring payment to medical homes after the Affordable Care Act, J Gen Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    African-American beneficiaries with T2D were less likely to receive LDL testing and retinal examinations and were more likely to be hospitalized than Caucasian beneficiaries.

    “African-American beneficiaries with T2D were less likely to receive LDL testing and retinal examinations and were more likely to be hospitalized than Caucasian beneficiaries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [107] Anderson, 2014, Quality of care and racial disparities in Medicare among potential ACOs, J Gen Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2005, the NCEP-ATP III criteria were modified to suggest lower waist circumference cutpoints for Asian Americans (≥90 cm in men and ≥80 cm in women).

    “In 2005, the NCEP-ATP III criteria were modified to suggest lower waist circumference cutpoints for Asian Americans ($90 cm [35 inches] in men and $80 cm [31 inches] in women) (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Grundy, 2005, Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In NHANES 2003-2006, MetS prevalence was 6.8% in normal-weight men, 29.8% in overweight men, and 65% in obese men, and 9.3%, 33.1%, and 56.1% in women, respectively.

    “In men in the NHANES (National Health and Nutrition Examination Survey) from 2003 to 2006, MetS was present in 6.8% of normal weight, 29.8 % of overweight, and 65% of obese individuals (14).Similarly, among women, 9.3% of normal weight, 33.1% of overweight, and 56.1% of obese individuals had MetS (14).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Ervin, 2009, Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006, Natl Stat Health Report

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Peer leaders can effectively provide education and support for lifestyle, as demonstrated in a study where 116 Latino adults with T2D were randomized to receive diabetes self-management education and either 12 months of weekly group sessions with peer leaders or 12 months of telephone outreach with health workers; both groups achieved significant HbA1c, blood pressure, and waist circumference

    “Finally, peer leaders can effectively provide education and support for lifestyle.This was demonstrated in a study where 116 Latino adults with T2D were randomized to receive diabetes self-management education and either 12 months of weekly group sessions with peer leaders or 12 months of telephone outreach with health workers (87).Both groups achieved significant HbA 1c , blood pressure, and”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [87] Tang, 2014, Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial, Diabetes Care source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In Colorado Heart Healthy Solutions, community health workers conducted screenings, assessed readiness for change, and provided education and medical referrals to patients with an uncontrolled risk factor for coronary heart disease or a Framingham Risk Score ≥10%; they found significant reductions in Framingham Risk score, blood pressure, and cholesterol at retesting, and in multivariable models,

    “In Colorado Heart Healthy Solutions, community health workers conducted screenings, assessed readiness for change, and provided education and medical referrals to patients with an uncontrolled risk factor for coronary heart disease or a Framingham Risk Score $10%.They provided further phone follow-up, and found significant reductions in Framingham Risk score, blood pressure, and cholesterol at ret”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85] Krantz, 2013, Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings, Am J Public Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A systematic review of 31 studies found a positive effect of components of the PCMH model on patient and staff experiences, as well as positive effects on preventive services, with reduction in emergency department visits in older adults, but no effect on hospital admissions or total costs.

    “A systematic review of 31 studies found a positive effect of components of the PCMH model on patient and staff experiences, as well as positive effects on preventive services, with reduction in emergency department visits in older adults, but no effect on hospital admissions or total costs (95).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [95] Jackson, 2013, Improving patient care. The patient centered medical home. A systematic review, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Recently, the AACE and the American College of Endocrinology developed an advanced framework for defining obesity as a chronic disease characterized by pathophysiological processes that result in increased adipose tissue mass and can result in increased morbidity and mortality, with MetS as one such important consequence.

    “Recently, the AACE and the American College of Endocrinology developed an advanced framework for defining obesity as a chronic disease characterized by pathophysiological processes that result in increased adipose tissue mass and can result in increased morbidity and mortality (40), with MetS as 1 such important consequence.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Garvey, 2014, American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease, Endocr Pract source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    MetS consists of elements that do not aggregate by chance alone and are causally inter-related, and each element contributes independently to an increased risk for ASCVD.

    “MetS consists of elements that do not aggregate by chance alone and are causally inter-related, and each element contributes independently to an increased risk for ASCVD (3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Yudkin, 2004, Low-grade inflammation may play a role in the etiology of the metabolic syndrome in patients with coronary heart disease: the HIFMECH Study, Metabolism source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A cultural adaptation of the DPP in African-American churches involving 37 participants compared an abbreviated 6-week program to a longer 16-week program and found that fasting glucose and BMI decreased significantly in both groups at 12 months.

    “Another cultural adaptation of the DPP in African-American churches involved 37 participants and compared an abbreviated 6-week program to a longer 16-week program; it found that fasting glucose and BMI decreased significantly in both groups at 12 months (90).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] Boltri, 2011, Translation of the National Institutes of Health Diabetes Prevention Program in African American churches, J Natl Med Assoc

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Lawrence Latino Diabetes Prevention project, which recruited 312 participants at high risk for T2D for a lifestyle intervention involving 3 individual and 13 group sessions over 12 months versus usual care, found a significant reduction in weight, BMI, and HbA1c in the intervention group as compared with usual care at 1 year.

    “To emphasize the importance of addressing disparities, the TT discussed key studies such as the Lawrence Latino Diabetes Prevention project (89), which recruited 312 participants at high risk for T2D for a lifestyle intervention involving 3 individual and 13 group sessions over 12 months versus usual care.The curriculum was adapted to address knowledge gaps and language barriers, customize dietary”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] Ockene, 2012, Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project, Am J Public Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There were some improvements in LDL testing for patients with T2D and ASCVD but not on other quality metrics in the commercial ACO evaluation.

    “There were some improvements in LDL testing for patients with T2D and ASCVD but not on other quality metrics (103).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [103] McWilliams, 2013, Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An evaluation of Medicare enrollees in the Medicare Physician Group Practice Demonstration compared with control subjects found that the savings were highest for acute care and dually-eligible beneficiaries, with an overall reduction in 30-day medical readmissions.

    “An evaluation of Medicare enrollees in the Medicare Physician Group Practice Demonstration compared with control subjects found that the savings were highest for acute care and dually-eligible beneficiaries, with an overall reduction in 30-day medical readmissions (104).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] Colla, 2012, Spending differences associated with the Medicare Physician Group Practice Demonstration, JAMA source

      Not checked in the free run.

53 of 53

  • The paper relies on this without support.

    There is no targeted comprehensive care approach to address the needs of MetS patients.

    “Second, there is no targeted comprehensive care approach to address the needs of MetS patients.”

  • The paper relies on this without support.

    There is no system to implement risk reduction and disease prevention for MetS.

    “Third, assuming there was such an approach, there is no system to implement risk reduction and disease prevention.”

  • The paper relies on this without support.

    The term MetS is the term most often used in scientific published data and by health care professionals.

    “TT participants concluded that MetS was the term most often used in the scientific published data and by health care professionals.”

  • The paper relies on this without support.

    Susceptibility to MetS transcends obesity, as there are obese individuals without MetS and nonobese individuals with MetS.

    “Susceptibility to MetS transcends obesity, however, as there are obese individuals without MetS and nonobese individuals with MetS.”

  • The paper relies on this without support.

    Several factors modulate the prevalence of MetS in the presence of obesity, including lifestyle factors such as poor nutritional quality and lack of physical activity.

    “Several factors modulate the prevalence of MetS in the presence of obesity, including lifestyle factors such as poor nutritional quality and lack of physical activity.”

  • The paper relies on this without support.

    Although risk for adverse outcomes generally increases with each subsequent stage of MetS, the absolute risk for developing MetS consequences varies substantially within populations.

    “It should be noted that although risk for adverse outcomes generally increases with each subsequent stage, the absolute risk for developing MetS consequences varies substantially within populations.”

  • The paper relies on this without support.

    Integrated health networks allow patients to monitor their own progress, which improves self-motivation and patient engagement in self-care.

    “Integrated health networks allow patients to monitor their own progress, which improves selfmotivation and patient engagement in self-care.”

  • The paper relies on this without support.

    The NCEP-ATP III criteria do not fully encompass the pathophysiological complexity of the syndrome, recognize predisposition to different types of end-organ damage, or account for health disparities according to race, sex, or socioeconomic status, in screening for or treating the syndrome.

    “However, these criteria do not fully encompass the pathophysiological complexity of the syndrome, recognize predisposition to different types of end-organ damage, or account for health disparities according to race, sex, or socioeconomic status, in screening for or treating the syndrome.”

  • The paper relies on this without support.

    MetS is typically under-recognized in the clinical setting, even just on the basis of the 5 standard criteria.

    “MetS is typically under-recognized in the clinical setting, even just on the basis of the 5 standard criteria.”

  • The paper relies on this without support.

    Additional elements of MetS include high apolipoprotein B, small low-density lipoprotein (LDL) particle size, endothelial dysfunction, insulin resistance, and prothrombotic and proinflammatory states.

    “Additional elements of MetS include high apolipoprotein B, small low-density lipoprotein (LDL) particle size, endothelial dysfunction, insulin resistance, and prothrombotic and proinflammatory states.”

  • The paper relies on this without support.

    These additional elements are less widely appreciated as components of MetS and are not typically measured in a clinical setting.

    “Not only are these less widely appreciated as components of MetS, but they are also not typically measured in a clinical setting.”

  • The paper relies on this without support.

    There is significant heterogeneity of expert opinion as to what constitutes MetS, to what degree it represents a syndrome or a disease, and whether it has any health-related effects.

    “There is significant heterogeneity of expert opinion as to what constitutes MetS, to what degree it represents a syndrome or a disease, and whether it has any health-related effects”

  • The paper relies on this without support.

    Disparity can manifest as decreased accessibility to health care and failure to recognize or appropriately treat at-risk populations.

    “Disparity can manifest as decreased accessibility to health care and failure to recognize or appropriately treat at-risk populations.”

  • The paper relies on this without support.

    Other nonracial, high-risk, under-represented populations likely requiring more intensive consideration include patients with human immunodeficiency virus/acquired immunodeficiency syndrome, cancer survivors, individuals with severe mental illness, and children with developmental disabilities.

    “Other nonracial, high-risk, under-represented populations likely requiring more intensive consideration include patients with human immunodeficiency virus/acquired immunodeficiency syndrome, cancer survivors, individuals with severe mental illness, and children with developmental disabilities.”

  • The paper relies on this without support.

    Many provisions of the Affordable Care Act (ACA) would support this implementation.

    “It is important to note that many of the provisions of the Affordable Care Act (ACA) would support this implementation.”

  • The paper relies on this without support.

    The PCMH addresses each of the aforementioned principles of care model implementation.

    “To varying degrees, the PCMH addresses each of the aforementioned principles of care model implementation.”

  • The paper relies on this without support.

    Comparisons across studies on the PCMH are often difficult because of differences in definition and focus.

    “However, comparisons across studies on the PCMH are often difficult because of differences in definition and focus.”

  • The paper relies on this without support.

    Long-term data on PCMH models is limited, as most of these models were implemented over the last 5 to 10 years.

    “Long-term data is also limited, as most of these models were implemented over the last 5 to 10 years.”

  • The paper relies on this without support.

    The PCMH model affects MetS sequelae and outcomes.

    “The PCMH model affects MetS sequelae and outcomes.”

  • The paper relies on this without support.

    There is less published data available to assess PCMH reimbursement strategies to facilitate coordinated care or on how this model addresses health care disparities.

    “There is less published data available to assess PCMH reimbursement strategies to facilitate coordinated care or on how this model addresses health care disparities.”

  • The paper relies on this without support.

    The ACO is a larger organization than the PCMH that includes hospitals and specialty care.

    “Although the PCMH focuses on coordination at the level of primary care, the ACO is a larger organization that includes hospitals and specialty care.”

  • The paper relies on this without support.

    Compared with many PCMH models, the ACO's reimbursement changes and cost-saving goals are more explicit and are better aligned to facilitate coordinated care.

    “Compared with many PCMH models, the ACO's reimbursement changes and cost-saving goals are more explicit and are better aligned to facilitate coordinated care.”

  • The paper relies on this without support.

    ACO design has not specifically addressed health care disparities.

    “Although integration of care into larger organizations may address health care disparities, this has not been specifically addressed in ACO design.”
23 of 23

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There is an increasing appreciation of the common pathophysiology and interrelationship of cardiometabolic risk factors leading to both adverse cardiovascular and adverse kidney outcomes in people with diabetes, including ASCVD, heart failure, and CKD.

    “There is an increasing appreciation of the common pathophysiology and interrelationship of cardiometabolic risk factors leading to both adverse cardiovascular and adverse kidney outcomes in people with diabetes, including ASCVD, heart failure, and chronic kidney disease (CKD) (16).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [16]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Metabolic syndrome is closely associated with diet.

    “Existing research indicates that metabolic syndrome is closely associated with diet [6].”

    From Impact of Dietary Patterns on Metabolic Syndrome in Young Adults: A Cross-Sectional Study (2024) · cites this paper as [6]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Sector count does not match the list

    Minor

    The text says the plan covers 8 sectors, but the subsequent semicolon-separated list names 11. Combining some entries could produce eight groups, but the list does not present them that way.

1 of 1

Cites

1 retracted

Flagged first, then by citations

3 of the 109 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
Sperling, L. S., Mechanick, J. I., Neeland, I. J., Herrick, C. J., Després, J.-P., Ndumele, C. E., Vijayaraghavan, K., Handelsman, Y., Puckrein, G. A., Araneta, M. R. G., Blum, Q. K., Collins, K. K., Cook, S., Dhurandhar, N. V., Dixon, D. L., Egan, B. M., Ferdinand, D. P., Herman, L. M., Hessen, S. E., Jacobson, T. A., Pate, R. R., Ratner, R. E., Brinton, E. A., Forker, A. D., Ritzenthaler, L. L., & Grundy, S. M.
Affiliations
  • Emory University (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • The University of Texas Southwestern Medical Center (US)
  • Washington University in St. Louis (US)
  • Institut universitaire de cardiologie et de pneumologie de Québec (CA)
  • Johns Hopkins University (US)
  • National Quality Forum (US)
  • University of California San Diego (US)
  • Inova Fairfax Hospital (US)
  • American Academy of Pediatrics (US)
  • Texas Tech University (US)
  • Virginia Commonwealth University (US)
  • University of South Carolina (US)
  • New York Institute of Technology (US)
  • University of Pennsylvania (US)
  • American Diabetes Association (US)
  • Foundation for Biomedical Research (US)
  • University of Missouri–Kansas City (US)
  • American College of Cardiology (US)
Corresponding author
Sperling, Laurence S.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2015-09
Volume
66
Issue
9
Pages
1050-1067
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2015.06.1328
OpenAlex
W1152644542
Cited by
294
References
109
Citations by year
2026: 20 · 2025: 21 · 2024: 38 · 2023: 30 · 2022: 28 · 2021: 33 · 2020: 27 · 2019: 28 · 2018: 21 · 2017: 21 · 2016: 25 · 2015: 2
FWCI
3.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
metabolic syndrome, cardiometabolic risk, patient care model, metabolic syndrome prevention, metabolic syndrome risk factors, consensus development
MeSH terms
Cardiovascular Diseases, Diabetes Mellitus, Type 2, District of Columbia, Health Promotion, Humans, Hypertension, Models, Cardiovascular, Obesity, Societies, Medical, Survival Analysis, Treatment Outcome, Evidence-Based Medicine, Metabolic Syndrome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Statistics and arithmetic are recomputed, not judged.

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