Журнал метаболического синдрома

Objective: Metabolic syndrome in obese teenagers may contribute to future cardiovascular disease (CVD). We designed a pilot study to evaluate the effect on carotid intima media thickness (cIMT) of Atorvastatin treatment over one year in dyslipidemic obese adolescents (DLP) with metabolic syndrome markers.

Methods: We conducted a randomized double blinded control study. Adolescents 14-18 years old were recruited; 16 DLP were randomized to either 10 mg Atorvastatin or placebo. Both groups had cIMT measurements on the left and right side before and one year after the intervention. These measurements were compared to those of teenagers with familial hypercholesterolemia (FH).

Results: The average left cIMT of the DLP group was 0.582 ± 0.073 mm, and the right, 0.536 ± 0.071 mm, this compared well with measurements from FH individuals, 0.569 ± 0.947 mm and 0.548 ± 0.913 mm (right and left respectively, p=0.49). For the DLP group, the average left cIMT decreased only in the statin group to 0.509 ± 0.041 mm (p=0.04) but not on the right side 0.555 ± 0.062 (p=0.5). On average cIMT decreased by 10% in Atorvastatin treated individuals and increased by 1.6% in placebo treated ones. CIMT correlated best with the diastolic pressure but not with any of the lipid values.

Conclusion: To our knowledge this is the first pilot study that showed cIMT regression in dyslipidemic obese teenagers with features of metabolic syndrome after Atorvastatin therapy over one year. However, future long term studies should look at long term CVD risk reduction.

Background: The aim of the present study were to evaluate the frequency of maternal complications and adverse fetal outcomes in a group of singleton pregnant women with type 2 diabetes mellitus to compare the outcome in three groups (lean, normal and overweight).

Materials and Methods: The women were categorized into three groups: lean <18.5, normal from 18.5 to 24.9 and overweight >25.0-29.9 kg/m2. The effect of pre-pregnancy BMI was analyzed by comparing the frequencies of various outcomes in three BMI groups. The results were expressed as odds ratio (ORs) and the corresponding 95% confidence intervals (CIs) & p values.

Results: The risk of late fetal death was consistently increasing with BMI (ORs were 1.2 (0.9-1.7), 1.6 (1.1-2.3) & 2.6 (1.7-3.8) for lean, normal & overweight respectively). The risk of early neonatal death was also higher among women with higher BMI (ORs was 1.6 (1.1-2.3) for overweight). The rate of preeclampsia is higher among women with lean and overweight BMI in compares to normal BMI (the values were 2.5%, 1.8%, & 7.0% for lean, normal & overweight respectively). Hypertensive disorders was also more common among lean (3.8%) and overweight (3.6%) compared to normal (1.6%). The risk of preterm delivery was significantly increased for overweight group (4.2%) and lean (2.4%), as compare to normal. The risk of SGA was significantly more in lean (2.7%) compared to normal weight (1.5%) & overweight group (1.9%).

Conclusion: Pre-pregnancy overweight increases the risk of late fetal death and perinatal mortality.

Objectives: The objectives of these studies are to evaluate: 1) uptake of a pulse dose of 13C16:1 cis-9 at varying levels into the blood and 2) glucose and insulin changes after pulse dose of 0 or 5 mg C16:1 cis-9/kg body weight (BW) under challenge conditions in obese lambs.

Methods: Two experiments were conducted to evaluate uptake of U-13C16:1 cis-9 into the blood and changes in glucose and insulin under challenges. In the first experiment, lambs (67.4 ± 1.4 kg BW, n=3) received jugular catheters and were used in a 3 x 3 Latin square. Treatments were 0, 2 or 5 mg/kg BW of U-13C16:1 cis-9 in 40% (wt/v) ethanol and blood samples were collected post infusion for glucose, fatty acid and insulin analyses. In the second experiment, lambs (86.7 ± 1.5 kg BW; n=4) received jugular catheters. Treatments were 0 or 5 mg/kg BW of C16:1 in 40% (wt/v) ethanol immediately followed by a glucose (0.25 g/kg) or insulin (0.02 mIU/kg) challenge.

Results: Both the 2 and 5 mg/kg BW dose of U-13C16:1 cis-9increased (P=0.003) C16:1 cis-9in serum compared to 0 mg/kg BW. The 5 mg/kg BW dose had a greater magnitude of increase for serum C16:1 and resulted in increased whole blood glucose levels for first 60 min and altered insulin levels for first 30 min. During the glucose tolerance test, C16:1bolus infusion increased (P=0.02) peak, overall, and area under the curve for plasma glucose levels. During the insulin challenge, C16:1-treated lambs had increased glucose levels (P=0.04) and peak, overall, and area under the curve plasma insulin (P=0.0001).

Conclusion: Palmitoleic acid infusion results in immediate uptake and clearance of serum palmitoleic acid, increases plasma glucose levels, and alters circulating insulin levels.

Background: There are multiple lines of evidence to suggest that chronic myocardial stress and increased cardiovascular risk is associated with the enhanced release of cardiac troponin in patients with ischemic heart disease. However, there is a paucity of data regarding the relation of cardiac troponin to the metabolic syndrome (MetS), a leading risk factor for cardiovascular morbidity.

Methods: We determined the prevalence of measurable high sensitivity cardiac Troponin T (hs-cTnT) with a fifth generation assay and evaluated its association to the presence of the male metabolic syndrome (MetS) components in a cohort of patients undergoing a health survey in the Tel Aviv Medical Center Inflammation Survey (TAMCIS).

Results: A total of 1,641 men with no known cardiovascular disease were recruited and MetS was diagnosed in 330 (20.1%) of them. Hs-cTnT concentrations were higher in patients with MetS (p<0.001). The number of MetS components was associated with the concentration ofhs-cTnT (p<0.001 for trend). The 99th percentile concentration was 27.6 ng/l and 16.03 ng/l for those with and without the MetS, respectively. Five percent of patients with MetS had hs-cTnT concentrations higher than the 99th percentile predetermined by the manufacturer.

Conclusions: The MetS in males is associated with higher levels of hs-cTnT than the general population, with each component increasing hs-cTnT value.

Objective: To investigate the occurrence and characterization of metabolic syndrome (MetS) in the long term after pregnancies with preeclampsia. Design: Retrospective cohort study. Setting: Assis Chateaubriand Maternity Teaching Hospital - Federal University of Ceará, Fortaleza, Ceará, Brazil. Sample: 68 patients who gave birth between 1992 and 2002 at the Maternity, 34 patients with a history of preeclampsia and 34 with no history of obstetric complications.

Methods: Blood pressure and body compositional indices were recorded. Fasting blood samples were tested for glucose, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol and triglycerides. A questionnaire was used to collect demographic data including family history of diseases associated with cardiovascular diseases. Criteria for metabolic syndrome were defined by International Diabetes Federation 2005 (IDF). Main outcome measures: Occurrence and characterization of MetS.

Results: There were 18 (52.9%) diagnoses of MetS in the group of women without a history of obstetric complications and 28 (82.3%) in the group of women with a history of preeclampsia, p=0.01 with a RR of 4.1 (CI 95% 1.4 - 12.2, p=0.009). The number of components to characterize MetS were, respectively, 2.7 ( ± 1.3) and 3.3 ( ± 1.3), p=0.05.

Conclusions: Women with a history of preeclampsia have a higher prevalence of MetS 14 years after gestation.

Background: The transition from customary African lifestyles to a “western” standard has resulted in the increase of obesity, abdominal adiposity and diabetes known to contribute significantly to morbidity and mortality rates around the world. We therefore aimed to identify the magnitude of overweight, obesity, abdominal adiposity and hypertension among a sample of patients with type 2 diabetes.

Methods: A sample of convenience was utilized to recruit all Type 2 diabetes patients that attended the 2013 World Diabetes day celebration. Sociodemographic information along with anthropometric measurements was taken (BMI, WC, WHR). Furthermore, blood pressure and fasting blood sugar level was measured for each participant.

Result: Out of the 468 diabetics that participated in this study, majority 248 (53.0%) were males and 220 (47.0%) females. The mean age and FBS was 42.6 ± 11.3 years and 6.9 ± 3.2mm/dl respectively. Hypertension was reported in 226 (48.3%) diabetics; while 182 (38.9%) were within the normal weight range, 41.0% (192) were overweight and 20.1% (94) were obese. A high WC was reported in 51.7% (n=242) and a high WHR in 52.6% (n=246). Obesity was significantly associated with middle-age (40-64 years) (p=0.001, F=15.4) and females (p=0.000, F=15.8). Those who were hypertensive had a significantly higher BMI (p=0.000, F=12.4), WHR (p=0.000, F=2.1) and WC (p=0.000, F=5.2). High WHR and WC was associated with higher FBS (p=0.000).There was a tenuous but significant difference in WHR by gender (p<0.05), with females having a higher WHR than males (0.88 ± 0.1 vs. 0.87 ± 0.1). There was a relationship between BMI, WC and WHR.

Conclusion: The proportion of obesity, abdominal adiposity and hypertension among type 2 diabetics is worrisome. Early diagnosis of obesity and abdominal adiposity and advice on lifestyle modification is imperative. Furthermore, a coherent and multifaceted public health strategy aimed at systematically debunking unhealthy myths and encouraging adoption of healthy lifestyles is imperative.

Aim: To study the role of crosstalk between SOCS3 and leptin on insulin expression in rat insulinoma (RIN-5AH) cells that inducibly express SOCS3 mRNA.

Materials and Methods: SOCS3 and preproinsulin mRNA expression induced by 5 μM ponasterone A, and the effects of leptin on SOCS3 and preproinsulin mRNA levels were detected by RT-PCR and quantitative PCR, respectively. The effects of SOCS3 on STAT3 phosphorylation were investigated by Western blot analysis.

Results: We discovered that SOCS3 regulates preproinsulin mRNA levels in a dose-dependent and timedependent manner. The insulin-suppressing effect of leptin appears to be mediated through reducing the suppressive effects of SOCS3 on STAT3 phosphorylation.

Conclusion: Our findings suggest that leptin inhibits preproinsulin mRNA expression induced by SOCS3 in RIN-5AH beta-cells.

Aim: This study was designed to clarify the difference in the effects of aerobic exercise training and diet on the improvement in the blood lipid profiles in patients with dyslipidemia.

Subjects and Methods: The study enrolled 86 patients with dyslipidemia [34 males and 52 females; age, 55 ± 10 years (33 to 71 years); low-density lipoprotein cholesterol (LDL-C), 150 ± 33 mg/dl (74 to 206 mg/dl); high-density lipoprotein cholesterol (HDL-C), 54 ± 12 mg/dl (35 to 87 mg/dl) and triglycerides, 165 ± 65 mg/dl (68 to 318 mg/dl)]. The subjects were randomly allocated to exercise training (n=42) or diet (n=44) group. These patients in the exercise training group were instructed to exercise for more than 300 min per week at the lactate threshold intensity. In the diet group, the target caloric intake was 25 kcal/kg of ideal body weight [height (m)2 × 22] according to the guideline of the Japan Society for the Study of Obesity.

Results: After the 12-week intervention, the LDL-C, triglyceride level and body weight decreased in both the exercise training and diet groups (p<0.05). There was no significant interaction effect for group × time on the LDL-C, fasting triglyceride level or body weight between the groups. The HDL-C increased only in the exercise training group, and a significant interaction effect for group × time was seen between the exercise training and diet groups for the HDL-C levels (p<0.05).

Conclusions: Based on our results, an improvement in the HDL-C level was observed in the exercise training group, but not in the diet group, despite the fact that the reductions in the LDL-C, triglycerides and body weight were not significantly different between the two groups. Therefore, these results suggest that lifestyle modification, especially exercise training, is considered to be important to reduce the risk of cardiovascular disease through by increasing the HDL-C.

Hypoplastic pituitary, a rare entity in itself and when presented to us requires a detailed evaluation and postoperative follow up. We are presenting a 48 year old lady who is short statured posted for epigastrichernioplasty. Detailed evaluation revealed secondary hypothyroidism, difficult airway, cardiomegaly, pericardial effusion, secondary adrenocortical insufficiency, growth hormone deficiency. CT scan of brain revealed cerebrospinal fluid filled sellar region and magnetic resonance imaging proved hypo plastic pituitary. After optimization with L-thyroxine she was planned for balanced general anaesthesia with epidural analgesia under steroid coverage. Peroperatively we faced resistant hypotension and due to inadequate reversal she was shifted to intensive care unit on ventilator. Subsequently we proved that her postoperative adrenocorticotropic hormone and cortisol level were low. However 24 hours later she could be extubated and finally she was discharged one week after the operation. However such cases are a challenge to the attending anaesthesiologist and as there is no strict protocol for anaesthetizing such a rare entity we have thought for detailing the case.

Alcoholic Liver Disease (ALD) is still a major problem in Western and Asian countries. The long-term impact of ALD might further lead to liver disease complications, such as liver cirrhosis and liver cancer. The safe limit amount of alcohol might be different between Western and Asian countries as the genetic factor might also become an important role in the liver disease progression.

It is well-known that alcohol consumption would have synergistic liver injury effect together with chronic viral hepatitis infection. However, in non-alcoholic fatty liver disease (NAFLD), mild to moderate alcohol consumption might have a beneficial effect as it might protect the liver.

Further studies will be needed to confirm the beneficial effect of mild to moderate alcohol consumption for protecting the liver as the liver disease progression in many countries might have different influenced factors, especially in chronic viral hepatitis infection due to different genetic polymorphism and different virus genotype distribution. Obesity, which is now becoming one of the biggest problems in NAFLD patients, it would also give a different prognosis in liver disease progression between Western and Asian countries because of different type of food habits and lifestyle.

Alcohol consumption issue would become the emerging controversies issue in the near future as NAFLD is now becoming an emerging disease despite chronic viral hepatitis infection.