The Predictive Value of CRP Levels on Future Severe Renal Disease in Overweight and Obese Subjects Without Diabetes Mellitus and Hypertension

Exercise augments weight loss induced improvement in renal function in obese metabolic syndrome individuals

OBJECTIVE

Metabolic syndrome (MetS) obesity is an independent risk factor for chronic kidney disease. This study was conducted to examine the effects of lifestyle interventions on renal parameters and putative metabolic, neuroadrenergic and hemodynamic mediators of renal injury.

METHODS

Untreated men and women (mean age 55 ± 1 years; BMI 32.7 ± 0.6 kg/m) without pre-existing renal dysfunction, who fulfilled MetS criteria were randomized to dietary weight loss (WL, n = 13), weight loss combined with aerobic exercise (WL + EX, n = 13), or no treatment (control, n = 12). Estimated glomerular filtration rate (eGFR), 24 h urinary albumin excretion, plasma renin activity (PRA), muscle sympathetic nerve activity (MSNA), baroreflex sensitivity (BRS), anthropometric, metabolic and fitness variables were measured at baseline and week 12.

RESULTS

Body weight decreased by -8.2 ± 0.8% in the WL and -10.7 ± 0.9% in the WL + EX groups (both P < 0.001). Fitness (maximal oxygen consumption) increased by 15 ± 5% and BRS by 5.5 ± 2.4 ms/mmHg in the WL + EX group only (P < 0.05). Serum creatinine decreased by -8.1 ± 4.8%, (WL, P = 0.016) and -14.9 ± 3.0% (WL + EX, P < 0.001). Estimated GFR increased commensurately but the increment was greater in the WL + EX group (P = 0.04). Albuminuria (P < 0.05) and MSNA (P < 0.001) decreased similarly in both groups, whereas PRA, high sensitivity C-reactive protein, uric acid and DBP decreased only in the WL + EX group (all P < 0.05).

CONCLUSION

Moderate weight loss in obese MetS patients is associated with a reduction in albuminuria and an improvement in eGFR which is augmented by exercise co-intervention.

Increased frequency of prediabetes in patients with irritable bowel syndrome

The aim of this study was to compare the occurrence of prediabetes [impaired fasting glucose and/or impaired glucose tolerance are considered to be precursors to type 2 diabetes mellitus (DM)] in irritable bowel syndrome (IBS) cases and matched controls. Ninety-two patients with IBS and 104 healthy matched controls were included in this study. Type 2 DM was considered an exclusion criterion in both groups. Fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were examined; after 1 night of fasting, an oral glucose tolerance test with 75 g glucose was administered, and the blood glucose levels after 2 hours were examined. Although there were no significant differences in the triglyceride levels, significant differences were found for total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels (P < 0.001, 0.001, and <0.001, respectively). These measures were found to be elevated in the IBS group compared with the control group. The frequency of prediabetes, which is regarded as the first stage of type 2 DM, was also found to be significantly higher in the IBS group (P < 0.001). After adjusting for potential confounders, such as age, lipid levels, and anthropometric measures in the analysis of covariance models, prediabetes was significantly more frequent in the IBS group than in the control group (P < 0.001). Thus, given the higher prediabetes occurrence in IBS, IBS may indirectly indicate a higher risk of DM. Further investigations will be necessary to fully elucidate the mechanisms behind these observations.

Altered alanine aminotransferase and gamma-glutamyl transpeptidase in women with history of preeclampsia: association with waist-to-hip ratio and body mass index

OBJECTIVE

Preeclampsia (PE), mostly when associated with HELLP syndrome, together with acute fatty liver of pregnancy, are the main causes of severe hepatic failure in pregnancy. Despite the number of studies in pregnancies complicated with PE, there are a few studies that focused on the evaluation of the hepatic function of these women several years after delivery. In this way, we evaluated circulating levels of AST, ALT, gammaGT and CRP several years after preeclamptic pregnancy to verify if these parameters are altered.

METHODS

Eighty-nine women with previous PE and 60 women without medical complications were invited to the research centers. After the physical examination, blood was drawn for biochemical measurements. Plasma CRP levels and serum concentration of AST, ALT, gammaGT were measured by automated enzymatic assays.

RESULTS

Systolic and diastolic blood pressures were significantly higher in women with history of PE than in control group as well as BMI and waist-to-hip ratio. ALT and gammaGT were significantly higher in women with previous history of PE, whereas AST and CRP presented similar levels between the two groups. Data revealed statistically significant positive correlations between ALT and gammaGT with waist-to-hip ratio and BMI. Positive correlations were also found between BMI and AST and CRP.

CONCLUSION

It is possible that the increase in ALT and gammaGT levels is due to being overweight or through accumulation of visceral fat. Unaltered values of CRP suggest that the higher ALT and gammaGT values found in women with history of PE are not associated with inflammation.