Metabolic syndrome: Early identification prevents type II diabetes and cardiovascular disease

Anti-diabetic Effect of Emblica-officinalis (Amla) Against Arsenic Induced Metabolic Disorder in Mice

Chronic exposure to arsenic through drinking water and occupational exposure has been found to be associated with the diabetic symptoms. Earlier, we reported that arsenic induced enhanced oxidative stress, inflammation, dislipidemia and hepatotoxicity in mice have been protected by treatment with Emblica officinalis (amla). The present study has therefore been focused to investigate the efficacy of amla in mitigation of arsenic induced hyperglycemia in mice. Arsenic exposure (3 mg/kg b.w./day for 30 days) in mice altered glucose homeostasis and significantly decreases hepatic glucose regulatory enzyme, glucokinase (43%), glucose-6 phosphate dehydrogenase (38%), malic enzyme (60%) and significantly increases the level of glucose-6 phosphates (65%), phosphoenolpyruvate carboxykinase (43%), lactate, (59%) Na+ (6.8%) Cl- (10.4%), anion gap (13.9%) and pancreatic (IL-1β, TNF-α) inflammation markers (52%, 53%) as compared to controls. Arsenic exposure also significantly decreased serum insulin (44%) and c-peptide protein (38%) in mice as compared to controls. Co-administration of arsenic and amla (500 mg/kg b.w./day for 30 days) balanced blood sugar level, hepatic glucose regulatory enzyme (glucokinase, glucose-6 phosphate dehydrogenase, malic enzyme (68%, 37%, 45%) and significantly decreases glucose-6 phosphatase (25%), phosphoenolpyruvate carboxykinase (22%), blood ion concentration and also lactate, Na+, Cl- and anion gap (20%, 4.6%, 6.7%, 5.2%), pancreatic (IL-1β, TNF-α) inflammation marker (21%, 24%) and significantly increased the serum insulin (57%) and c-peptide protein (31%) as compared to those treated with arsenic alone. Results of the present study suggests that the hypoglycemic and antioxidant property of amla could be responsible for its protective efficacy in arsenic induced hyperglycemia.

Diabetes mellitus and high blood pressure in relation to BMI among adult non-pregnant women in Bangladesh

PURPOSE

To investigate the association between overweight and obesity (in terms of BMI) and diabetes, HBP and diabetes-HBP comorbidity among adult women non-pregnant in Bangladesh.

METHODS

Information about demographics, socioeconomic, blood pressure and blood glucose levels were collected for 2022 women ageing above 35 years were collected from Bangladesh Demographic and Health Survey (BDHS 2011). The primary outcome variables were diabetes and high blood pressure. Diabetes was defined as fasting plasma glucose value ≥7.0mmol/L and HBP as systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg. Blood pressure and plasma glucose measurement were performed by standard clinical procedures. Data were analysed using cross-tabulation, chi-square tests and logistic regression methods.

RESULTS

Mean age of the participants was 41.42 (SD=4.37). 38.7% of the women had BMI values ≥25. The prevalence of HBP, diabetes, and diabetes-HBP comorbidity was respectively 18% and 5.1%, and 2%. The adjusted odds of having diabetes, HBP and Diabetes-HBP comorbidity were respectively 2.14 (p=0.002; 95%CI=1.31-3.48), 2.3 (p=<0.0001; 95%CI=1.70-2.98), and 3.4 (p=0.004; 95%CI=1.47-7.81) times higher among overweight/obese women compared to those with normal weight.

CONCLUSIONS

Overweight and obesity account for a major proportion of diabetes, HBP and the comorbidity of these two among non-pregnant women. There remains a considerable risk for future expansion of diabetes and HBP as the prevalence of overweight/obesity is rising constantly. Maintaining a healthy BMI needs to be regarded as among the most important diabetes and HBP preventive strategies among Bangladeshi women.

Microalbuminuria in Obese Young and Middle Aged Population: A Potential Marker of Cardiovascular Risk

Microalbuminuria is an established cardiovascular risk indicator in diabetes, hypertension and the general population. There is lack of information on MAU in healthy obese Indian adults and an ongoing debate whether obese adults deserve targeted identification and clinical intervention for MAU and prediabetes. We aimed to screen the healthy obese, young (group I) and middle aged (group II) adults for prevalence of MAU and prediabetes and study its association with Framingham risk score. The study included 50 healthy obese young (20-30 years) and middle aged adults (31-50 years), attending the outpatient clinic of Dept. of Medicine for a duration of 2 months (July-August). The patients were screened for fasting blood sugar, lipid profile and MAU. Of the total patients 28 % had MAU, 32.14 % of which had prediabetes and 33.33 % had diabetes whereas 10 % were normoglycemic. The group I patients had 50 % cases of MAU and group II had 25 % patients with MAU. Group II 63.63 % pre-diabetics. The values of MAU obtained were correlated with age, gender, body mass index, systolic and diastolic blood pressure, FBS, waist to hip ratio using Pearson's Coefficient (p < 0.05). The 10 year CVD risk calculated using FRS in subjects with MAU was higher as compared to those without MAU. Thus we conclude that Indian, young and middle aged obese adults to be at a risk of prediabetes, MAU and CV risk warranting their routine screening for better clinical outcomes.

Association of Resistin with Insulin Resistance and Factors of Metabolic Syndrome in North Indians

Metabolic syndrome (MetS) is a cluster of interrelated common clinical disorders. The role of resistin in insulin sensitivity and MetS is controversial till date. So, the aim of the present study was to investigate the relationship of plasma resistin levels with markers of the MetS in Indian subjects. In a case control study, total 528 subjects were selected for the study. 265 (194 male and 71 female) were cases (with MetS) and 263 (164 male and 99 female) were controls (without MetS). Required anthropometric measurements and calculations were carried out accordingly. All the Biochemical estimations were carried out according to standard protocol. Resistin level was measured by the standard protocol (By ELISA i.e. enzyme linked immunosorbent assay) as illustrated in the kit. Insulin level was also measured by the standard protocol as illustrated in the kit and insulin resistance was calculated by the standard procedures. Plasma resistin levels were significantly higher in cases compared with controls (male = 13.05 ± 4.31 vs. 7.04 ± 2.09 ng/ml; p ≤ 0.001 and female = 13.53 ± 4.14 vs. 7.42 ± 2.30 ng/ml; p ≤ 0.001). Plasma resistin levels were well correlated with waist circumference, glucose, triglycerides, waist/hip ratio, systolic and diastolic blood pressure, high density lipoprotein, total cholesterol, serum low density lipoprotein, serum very low density lipoprotein, insulin and insulin resistance. Plasma resistin levels were elevated in presence of the MetS and were associated with increased metabolic risk factors.

Study of metabolic syndrome and its risk components in patients attending tertiary care center of uttarakhand

Metabolic syndrome is a complex of metabolic factors which includes central obesity, insulin-resistance, dyslipidemia and hypertension. Metabolic syndrome is associated with increased risk of cardiovascular disease. This study aimed to know the rate of metabolic syndrome in outpatients presenting to medicine department of our hospital and their profile. The metabolic syndrome was diagnosed using International Diabetes Federation criteria. The parameters analyzed included age, sex, blood pressure, BMI, fasting plasma glucose, HDL and triglycerides. The rate of metabolic syndrome was 21.1 % in our study. The younger population was most susceptible to metabolic derangements. Further, females were found to be affected more than males. The extremely significant parameters were deranged fasting plasma glucose, HDL, triglycerides while hypertension was found to be insignificant. Being overweight maybe a strong predictor for presence of metabolic syndrome in our region of study, and all overweight persons should be assessed and appropriately treated to prevent future cardiovascular events.

Reference interval for lipid profile in North Indian population from Rajasthan according to various partitioning criteria

OBJECTIVE

Lipid profile parameters are influenced by various factors like age, ethnicity, diet, genetic and gender differences hence it is essential to establish reference range of the values of serum lipids for a given population in India. We have planned this study to evaluate the reference values of lipid profile of a North Indian population according to the guidelines of the National Cholesterol Education Program (NCEP) of the USA.

DESIGN AND METHODS

The present study was conducted on 2021 apparently healthy individuals of North Indian origin ranging in age from 15 to 60 years, who were selected randomly using defined criteria. Fasting samples were analyzed for total cholesterol, triglyceride, HDL-C and LDL-C. Data were analyzed for middle 95th percentile (2.5th-97.5th percentile), median and 95% confidence interval using SPSS software package version 10.0.

RESULTS

No substantial difference could be observed between male and female and vegetarian and non-vegetarian, in cholesterol, triglyceride and LDL-C levels. However HDL-C reported higher limit in female as compared to male (33-64 vs 32-58 mg/dl). Similarly upper limit of HDL-C in vegetarians were higher than non-vegetarian (value 32.8-64.92 vs 30.72-58.10mg/dl). Median value for cholesterol, triglyceride, LDL-C progressively increased in different age groups (<20, 20-40 and 41-60 years). No marked difference was observed in reference interval of these parameters in rural and urban populations.

CONCLUSION

It can be suggested that lipid values obtained in this study can be used as the reference value, based on which clinical correlation can be made.

Prevalence of metabolic syndrome among an urban population in Kenya

OBJECTIVE

Developing countries are undergoing an epidemiologic transition accompanied by increasing burden of cardiovascular disease (CVD) linked to urbanization and lifestyle modifications. Metabolic syndrome is a cluster of CVD risk factors whose extent in Kenya remains unknown. The aim of this study was to determine the prevalence of metabolic syndrome and factors associated with its occurrence among an urban population in Kenya.

RESEARCH DESIGN AND METHODS

This was a household cross-sectional survey comprising 539 adults (aged ≥18 years) living in Nairobi, drawn from 30 clusters across five socioeconomic classes. Measurements included waist circumference, HDL cholesterol, triacylglycerides (TAGs), fasting glucose, and blood pressure.

RESULTS

The prevalence of metabolic syndrome was 34.6% and was higher in women than in men (40.2 vs. 29%; P < 0.001). The most frequently observed features were raised blood pressure, a higher waist circumference, and low HDL cholesterol (men: 96.2, 80.8, and 80%; women: 89.8, 97.2, and 96.3%, respectively), whereas raised fasting glucose and TAGs were observed less frequently (men: 26.9 and 63.3%; women: 26.9 and 30.6%, respectively). The main factors associated with the presence of metabolic syndrome were increasing age, socioeconomic status, and education.

CONCLUSIONS

Metabolic syndrome is prevalent in this urban population, especially among women, but the incidence of individual factors suggests that poor glycemic control is not the major contributor. Longitudinal studies are required to establish true causes of metabolic syndrome in Kenya. The Kenyan government needs to create awareness, develop prevention strategies, and strengthen the health care system to accommodate screening and management of CVDs.

Hyperinsulinemia predisposes to NAFLD

Metabolic syndrome contributes to pathogenesis of Type-2 diabetes and CAD. Insulin Resistance is the key factor of metabolic syndrome implicated in development of Non Alcoholic Fatty Liver Disease (NAFLD). In present study we have investigated the prevalence of NAFLD in metabolic syndrome and contribution of metabolic risk factors in causation of NAFLD in non-diabetic North Indian male population. The study was conducted on 495 non-diabetic, nonalcoholic subjects (age 30-65 years). Metabolic Syndrome was assessed by using ATP III and ADA (2005) criteria. Anthropometric factors-Waist circumference and blood pressure were measured. Fasting serum samples were analyzed for Glucose, Triglycerides, Cholesterol and its fractions, Insulin, Alanine transaminase, Aspartate transaminase, Gamma glutamyl transferase and free fatty acids. Insulin resistance was estimated by Homeostasis Model and Insulin sensitivity by QUICKI Index. Liver ultrasonographic scanning was used for assessing fatty liver. The prevalence of metabolic syndrome and NAFLD was 24% and 14.8% respectively in non-alcoholic population and 27% of metabolic syndrome had NAFLD which was associated with hyperinsulinemia, insulin resistance, insulin insensitivity along with elevated levels of waist circumference, blood pressure, triglyceride, FFA and decreased HDL-Cholesterol. The prevalence of NAFLD increased with insulin resistance and clustering of metabolic risk factors.