Clinical Outcomes in Metabolic Syndrome

Diet-induced obesity causes metabolic impairment independent of alterations in gut barrier integrity

SCOPE

The causal relationship between diet-induced obesity and metabolic disorders is not clear yet. One hypothesis is whether the obese state or high-fat diet per se affects intestinal barrier function provoking metabolic comorbidities.

METHODS AND RESULTS

In three independent experiments with AKR/J, SWR/J, or BL/6J mice, we addressed the impact of genetic background, excess body fat storage, duration of high-fat feeding, and quality/quantity of dietary fat on glucose tolerance and gut barrier integrity in vivo and ex vivo. Impaired glucose tolerance in diet-induced obese BL/6J and AKR/J mice was not accompanied by an altered intestinal barrier function. Enforced dietary challenge by prolonged feeding and increasing fat quantity in BL/6J mice still failed to aggravate metabolic and intestinal deterioration. Despite a low-grade inflammatory status in adipose tissue, barrier function of BL/6J mice fed lard high-fat diet revealed no evidence for a diet-induced loss in barrier integrity.

CONCLUSION

None of our results provided any evidence that gut barrier function is a subject to dietary regulation and obesity per se seems not to cause gut barrier impairment.

Obesity and surgical wound healing: a current review

Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population.

Peroxisome proliferator-activated receptor gamma concentrations in newly diagnosed hypertension patients and the metabolic effects of olmesartan

BACKGROUND AND AIMS

We undertook this study to investigate the effects of olmesartan treatment on PPAR-gamma (PPAR-γ) concentrations and metabolic syndrome (MetS) components in hypertensive (HT) patients.

METHODS

The study included 46 newly diagnosed hypertensive patients and 30 healthy controls. All hypertensive patients were given 40 mg of olmesartan, and they were evaluated weekly in the first month and then twice weekly during follow-up visits. At the end of 3 months, MetS components were assessed and serum PPAR-γ transcription factor concentrations were again measured.

RESULTS

MetS was noted in 80.4% of HT patients. Serum PPAR-γ transcription factor concentration were significantly lower in those with HT compared with the controls (p = 0.005). PPAR-γ concentrations of controls were 1.14-fold higher than hypertensive patients. HDL levels were significantly increased after treatment (p = 0.004), triglyceride, total cholesterol, fasting blood glucose (FBG), and LDL levels were significantly reduced (p <0.05). There was a tendency toward increased PPAR-γ concentrations after treatment, but these were not statistically significant (p = 0.154).

CONCLUSIONS

Olmesartan treatment was found to generate beneficial effects on MetS parameters in HT patients but did not produce any significant increases in serum PPAR-γ transcription factor concentration.

Treatment with marine collagen peptides modulates glucose and lipid metabolism in Chinese patients with type 2 diabetes mellitus

This study was aimed at examining the therapeutic effects of marine collagen peptides (MCPs) from fish hydrolysate in Chinese patients with type 2 diabetes mellitus (T2DM). A total of 100 diabetic patients and 50 healthy controls were recruited. Diabetic patients were randomized into treatment and control groups. The patients in the treatment group received an additional 13 g of MCPs daily for 3 months. Their blood samples were collected before, and 1.5 and 3 months after, treatment to evaluate glucose and lipid metabolism. The levels of serum high-sensitivity C-reactive protein (hs-CRP), nitric oxide (NO), bradykinin, prostacyclin (PGI2), and adipokines were determined. Significantly reduced levels of fasting blood glucose, human glycated hemoglobin A1c (GHbA1c), fasting blood insulin, total triglycerides, total cholesterol, low-density lipoprotein, and free-fatty acids, but increased levels of insulin sensitivity index and HDL were observed in T2DM patients following treatment with MCPs for 1.5 and 3 months. The values of these measures were significantly lower or higher than those of patient controls (p < 0.01), respectively. Interestingly, significantly decreased levels of hs-CRP and NO, but increased levels of bradykinin, PGI2, and adiponectin were detected in MCP-treated T2DM patients (p < 0.01), as compared with their basal values or the levels in patient controls. MCP treatment improved glucose and lipid metabolism in diabetic patients.

Chlamydia pneumoniae IgA and elevated level of IL-6 may synergize to accelerate coronary artery disease

OBJECTIVES

A strong association of cytokines [interleukin (IL)-6, IL-2 and tumor necrosis factor (TNF)-alpha] with atherosclerosis is well documented. However, their role in Chlamydia pneumoniae (Cp)-associated progression of coronary artery disease (CAD) is not well studied. Hence we evaluated the presence of these cytokines in CAD patients positive for Cp immunoglobulin (Ig) A (low, medium, and high levels) CAD and compared with controls. Also the physiological and baseline characteristics in IL-6 positive CAD patients were studied.

METHODS

During the period from March 2005 to June 2007, 192 CAD patients and controls attending the cardiology clinic of Safdarjung Hospital, New Delhi, India were enrolled. ELISA was performed for the estimation of Cp IgA, high sensitive C-reactive protein (hsCRP), and cytokines IL-6, IL-2, and TNF-alpha in CAD patients and controls.

RESULTS

IL-6 was significantly higher in CAD patents with medium and higher Cp IgA levels (35 vs. 10 and 32 vs. 4) compared to controls. Physiological features and baseline characteristics of CAD were significantly higher in IL-6 positive CAD patients. Additionally, in CAD patients IL-6 was significantly correlated with hsCRP (p<0.001, r=0.42).

CONCLUSIONS

Our results lead us to hypothesize the role of IL-6 in the pathogenesis of CAD, which may subsequently get accelerated through Cp infection.