[Insulin resistance/hyperinsulinemia associated diseases not included in the metabolic syndrome]

Juice from leaves of cacti of the genus Pereskia: effect on the physiological parameters of Wistar rats

Abstract The objective was to evaluate whether the juice from the leaves of cacti of three species of the genus Pereskia promotes changes in the physiological parameters of Wistar rats. The study was divided into stage 1 (obesity induction with a hypercaloric diet, monosodium glutamate, and sucrose solution), and stage 2 (use of cactus juice). The data of body weight, Body Mass and Lee Indexes, feed intake, adipose tissue mass, and Visceral and Epididymal Fat Indexes were compared by the Tukey test at 5%. Monosodium glutamate and sucrose in association with the hypercaloric diet did not increase adipose tissues. No statistical difference was found between the means of body weight, Body Mass Index and Lee Index, liver weight, and Hepatosomatic Index. Pereskia grandifolia juice promoted a lower total weight gain due to the low feed intake. Pereskia aculeata juice increased the visceral adipose tissue mass. Thus, the Pereskia grandifolia juice presented a better effect on weight gain. These cacti are rich in nutrients and bioactive compounds that can improve food quality, and prevent chronic non-communicable diseases.

Assessment of fructose overload in the metabolic profile and oxidative/nitrosative stress in the kidney of senescent female rats

The aging process is a complex phenomenon that leads the body to several changes, affecting its integrity and resulting in chronic pathologies, which compromises health and quality of life of elderly people. Animals supplemented with fructose have been used as an experimental model for induction of insulin resistance. The objective of this study was to evaluate the metabolic effects and the levels of oxidative/nitrosative stress in the kidney of senescent rats with a high fructose intake. The animals were allocated into 4 groups: young control (Y), aged control (A), young fructose (YF) and aged fructose (AF). Groups Y and A received water and groups YF and AF received fructose (100g/L) in the water, both ad libitum. After 12weeks of high fructose intake, the animals were sacrificed to collect their kidneys, blood and the thoracic aorta. The results are presented as mean±SE, analyzed by the One-Way ANOVA test with Newman-Keuls post-test; significant at p<0.05. The fructose overload caused metabolic dysfunctions and insulin resistance, confirming the efficacy of the chosen model. In this study, we observed a body weight gain in the studied groups (except in the elderly fructose group), and an increase in general caloric intake, diuresis and adipose tissue; insulin resistance, increased fasting glucose, triglycerides and cholesterol in the fructose groups. We also found a loss of renal function, increased oxidative/nitrosative stress and inflammation, and a reduction of antioxidants and a lower vasodepressor response in the studied groups, especially those who consumed fructose. In summary, our data showed that aging or high fructose intake contributed to the increase of oxidative/nitrosative stress in animals, demonstrating that at the dose and the period of fructose treatment utilized in this study, fructose was not able to aggravate several aspects which were already altered by aging. We believe that the high fructose intake simulates most of the effects of aging, and this understanding would be useful to prevent or minimize many of the alterations caused by this condition.

Overweight, obesity and the risk of gallbladder and extrahepatic bile duct cancers: A meta-analysis of observational studies

OBJECTIVE

Epidemiological studies have repeatedly investigated the association between excess body weight and the risk of biliary tract cancer with inconsistent results. The objective of this study was to quantitatively assess the associations between overweight and obesity and the risk of biliary tract cancer.

METHODS

A comprehensive search of PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases up to August 2015 was conducted, and the reference lists of retrieved articles for additional relevant studies were manually searched.

RESULTS

Fourteen prospective cohort studies and 15 case-control studies were included in this meta-analysis. These studies included 11,448,397 participants (6,733 patients with gallbladder cancer [GBC] and 5,798 patients with extrahepatic bile duct cancer [EBDC]) with follow-up durations ranging from 5 to 23 years. Among overweight adults, the pooled RR was 1.17 (95% CI, 1.07-1.28) for GBC and 1.26 (95% CI, 1.14-1.39) for EBDC, and among people with obesity, the pooled RR was 1.62 (95% CI, 1.49-1.75) for GBC and 1.48 (95% CI, 1.21-1.81) for EBDC. Visual inspection of the funnel plots and the Begg's and the Egger's tests did not show enough evidence of publication bias.

CONCLUSIONS

Integrated evidence from this meta-analysis suggests that excess body weight is associated with a significantly increased risk of GBC and EBDC.

Effect of Myoinositol and Antioxidants on Sperm Quality in Men with Metabolic Syndrome

This prospective longitudinal study investigated the effects of a dietary supplement in patients affected by reduced sperm motility (asthenospermic males) with metabolic syndrome. The product tested was Andrositol®, which contains myoinositol (MI) as principal compound, in association with other molecules, and the parameters evaluated were semen characteristics as well as hormone and metabolic profiles. The inclusion criteria were subjects aged over 18 years, with asthenospermia and metabolic syndrome. The exclusion criteria were presence of cryptorchidism, varicocele, and prostatitis. For this study, 45 males who had such features were enrolled. Their selection was made according to the 2010 World Health Organization (WHO) criteria (5th Edition) for the Evaluation of Human Semen. Hormone and metabolic profiles and semen parameters were assessed at the beginning of the study and after three months of treatment with Andrositol. The differences between the values before and after the supplementation were found statistically significant. Andrositol normalized the metabolic profile of these patients, improving their insulin sensitivity. Moreover, testosterone levels were increased and the semen characteristics, such as sperm concentration, motility, and morphology, highly improved. In conclusion, the association of MI with other molecules (micronutrients and vitamins) could be an effective therapy for metabolic disorders, as well as hormonal and spermatic changes responsible for male infertility.

Resistência à insulina e componentes da síndrome metabólica, análise por sexo e por fase da adolescência

Objetivo: Analisar a influência dos componentes da síndrome metabólica na resistência à insulina, por sexo e fase da adolescência. Sujeitos e métodos: Avaliaram-se dados bioquímicos, clínico, de estilo de vida e composição corporal de 800 adolescentes de 10 a 19 anos, de ambos os sexos, de Viçosa-MG/Brasil, divididos em fases: inicial (10 a 13 anos), intermediária (14 a 16 anos) e final (17 a 19 anos). Resultados: 10,3 e 3,4% apresentavam, respectivamente, resistência à insulina e síndrome metabólica. Na fase inicial, observaram-se maior prevalência de dislipidemia e na intermediária, de hiperuricemia e excesso de gordura corporal. O sexo feminino apresentou maior prevalência de dislipidemia, excesso de gordura corporal e resistência à insulina e o masculino, maior prevalência de HDL baixo, hiperuricemia e pressão arterial alterada. Os da fase inicial apresentaram maiores valores de colesterol total, LDL, HDL, triglicerídeos, glicemia de jejum e relação cintura/quadril, ficaram menos tempo sentados e realizavam maior número de refeições (p < 0,05) em relação às outras fases. O modelo final, ajustado por sexo, foi diferente para cada fase da adolescência. Conclusões: A resistência à insulina está associada à inadequação na composição corporal, nos níveis bioquímicos e no estilo de vida, sendo os fatores associados diferentes em cada fase da adolescência. Arq Bras Endocrinol Metab. 2014;58(6):610-8

[Nonalcoholic fatty liver disease and its association with metabolic syndrome in the preoperative period in patients undergoing bariatric surgery]

OBJECTIVE

To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) in the preoperative period in patients undergoing bariatric surgery.

METHODS

A total of 68 medical records of patients from a center for advanced treatment of obesity in the city of Caxias do Sul, state of Rio Grande do Sul, Brazil, were reviewed. The variables analyzed were gender, age, biochemical parameters (fasting glucose, HDL-cholesterol and triglycerides), abdominal ultrasound, blood pressure, and anthropometric data (weight, height, waist circumference, and body mass index [BMI]). The diagnosis of NAFLD was obtained by abdominal ultrasonography; the diagnosis of of MS was obtained according to the protocol described by the National Cholesterol Education Program's Adult Treatment Panel III, updated by the American Heart Association; and the National Heart, Lung, and Blood Institute.

RESULTS

72.1% (n=49) of the sample consisted of females, and the mean age for the sample was 37.57±10.29 years. The mean weight was 123.14±25.40kg, mean height was 1.67±0.09 m, and mean BMI was 56.24±9.30kg/m(2). A total of 60% (n=27) of patients with MS (p=0.008), 63.4% (n=26) of patients with hypertension (p=0.013), and 66.7% (n=18) of patients with altered glucose levels (p=0.028) were diagnosed with NAFLD.

CONCLUSION

The results of this study showed that the diagnosis of MS, as well as the presence of disorders associated with this syndrome (obesity, hypertension, and high blood glucose levels) are strongly associated with the presence of NAFLD.

Effect of a hyperlipidic diet rich in omegas 3, 6 and 9 on aberrant crypt formation in rat colonic mucosa

PURPOSE

To determine whether a hypercaloric and hyperlipidic diet enriched with polyunsaturated fatty acids influences the formation of aberrant crypt foci (ACF) in colonic mucosa of Wistar rats treated with azoxymethane (AOM).

METHODS

At eight weeks of life, the rats were assigned to four groups: Group I-standard diet (STD) not treated with AOM; Group II-hypercaloric and hyperlipidic diet (FED), not treated with AOM; Group III-STD, treated with AOM; Group IV-FED, treated with AOM. At 16 weeks, the animals were injected intraperitoneal with 0.9% saline solution (Group I and II) or AOM at 15 mg/Kg (Groups III and IV) once a week for two weeks. Fifteen weeks later, the animals were euthanized.

RESULTS

FED promoted weight gain in Groups II and IV compared to Groups I and III, respectively. The groups did not differ with regard to the total number of ACF. The Chi-square test revealed no predominance of the presence of foci with <4 crypts. However, foci with ≥5 crypts were proportionally more prevalent in Group III than in Group IV (p=0.043).

CONCLUSION

The administration of polyunsaturated fatty acids did not interfere with the formation of aberrant crypt foci, but reduced ACF multiplicity, exercising an attenuating effect on carcinogenesis.

Prevalência de esteatose hepática e consumo de álcool em participantes do Projeto Atividade Física na Vila

A esteatose hepática é um achado cada vez mais frequente em exames de rastreamento por estudo de imagem. Tem sido descrita associação entre esteatose, obesidade, resistência à insulina e síndrome metabólica (SM). Também parece existir sinergismo entre esteatose hepática, álcool e fibrose hepática. O objetivo foi descrever a prevalência de esteatose e de etilismo nos participantes do Projeto “Atividade Física na Vila” e avaliar sua associação com a presença de obesidade e obesidade visceral. Foi realizada ultrassonografia abdominal em 69 participantes, 53,02±1,26 anos, sendo avaliados a presença e o grau de esteatose e as medidas da gordura subcutânea e visceral (GV). Foram excluídos os pacientes com hepatite viral e com etilismo significativo na anamnese ou após teste AUDIT. Após análise inicial, 60 pacientes foram avaliados quanto aos dados antropométricos e divididos em 2 grupos: com e sem esteatose. A prevalência de etilismo foi de 8,7%. A esteatose hepática foi observada em 37% dos pacientes sendo a maioria classificada como leve e moderada (91%). O grupo com esteatose apresentou aumento significativo de IMC (34,±8,7 versus 29,8±6,5kg/m2), cintura abdominal (102,6±12,7 versus 95,3±12,3cm), peso (85,8±18,7 versus 74,5±17,7kg) e GV (47,9±10,5 versus 36,0±12,7mm). A esteatose hepática é comum em obesos, especialmente naqueles com obesidade visceral. Sabemos que o álcool e a obesidade visceral podem estar envolvidos em seu mecanismo fisiopatológico. Por isso, os pacientes com esteatose hepática e consumo excessivo de álcool podem apresentar maior chance de evoluir desfavoravelmente para a cirrose e insuficiência hepática.

Relationship between insulin and hypogonadism in men with metabolic syndrome

OBJECTIVE

To evaluate the incidence of hypogonadism in men with metabolic syndrome and its correlation with serum insulin levels.

METHODS

Observational, transversal study with 80 men with metabolic syndrome. The individuals were divided into two groups: Group 1: 56 patients (70%) with total testosterone > 300 ng/dL (normal gonadal function); Group 2: 24 patients (30%) with total testosterone < 300 ng/dL (hypogonadic).

RESULTS

The subjects from Group 2 compared to Group 1 presented higher body mass index (BMI), waist and hip circumferences, insulin, homeostasis model assessment insulin resistance index (Homa-IR) and beta cell (Homa-beta), and triglycerides, but lower SHBG and free testosterone values. Inverse correlations between insulin levels and total testosterone and SHBG, as well as between Homa-IR and total testosterone were observed.

CONCLUSION

In this series of men with metabolic syndrome, hypogonadism was associated with insulin resistance and may be a marker of metabolic abnormalities.

Obesity in children and adolescents: the relation between metabolic syndrome and non-alcoholic fatty-liver disease

This article aims to review clinical and diagnostic aspects of non-alcoholic fatty liver disease associated with obesity and its relation to metabolic syndrome in children and adolescents. An on-line search was carried out of original articles in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Eletronic Library Online (SciELO) databases, using the following key words: "hepatic steatosis", "nonalcoholic fatty liver diseases", "overweight", "obesity", "children", "adolescents", "ultrasound" and "metabolic syndrome" in English and Portuguese. Two hundred and seventy-five articles were initially selected, all published between 1993 and 2008. After reading this was narrowed down to 67. The literature consulted revealed no consensus regarding the need to screen for metabolic syndrome and non-alcoholic fatty liver disease, especially in obese children and adolescents and those who have excess fat in the abdominal region. An ultrasound examination of the liver is typically used for screening and, in the case of children who present alterations in aminotransferases in addition to fatty infiltration of the liver, a strict clinical follow-up and a liver biopsy are recommended if these symptoms do not disappear on treatment.

Associação entre acrocórdons e resistência à insulina

FUNDAMENTOS: Acrocórdons são lesões dermatológicas comuns na população e estão associados ao diabetes mellitus, à obesidade, à resistência insulínica e à aterosclerose. A identificação precoce de pacientes com resistência insulínica pode ter papel preventivo primário. OBJETIVO: Avaliar a associação entre presença de acrocórdons cervicais ou axilares e resistência insulínica. MÉTODOS: Estudo transversal com pacientes dermatológicos adultos atendidos em hospital universitário. Casos foram definidos como portadores de mais de cinco acrocórdons cervicais e/ou axilares. A resistência insulínica foi estimada pelo índice HOMA-IR. Resultados foram ajustados pelas demais covariáveis de risco para resistência insulínica conhecidos, a partir de regressão logística múltipla. RESULTADOS: Avaliaram-se 98 casos e 103 controles, que não diferiram entre si quanto à idade ou ao gênero. Acrocórdons se associaram diretamente aos valores de HOMA-IR (Odds Ratio = 1,4), hipertrigliceridemia e índice de massa corpórea, independentemente do ajuste por diabetes mellitus, idade, fototipo, gênero, história de diabetes mellitus familiar e relação cintura/quadril. Níveis qualitativamente elevados de HOMA-IR (> 3,8) também evidenciaram associação significativa (Índice de probabilidade = 7,5). CONCLUSÕES: Presença de múltiplos acrocórdons se associou à resistência insulínica, independentemente dos demais fatores de risco.

Immunological, Hematological, and Glycemia Effects of Dietary Supplementation withAgaricus sylvaticuson Patients’ Colorectal Cancer

Objective: The aim of this study was to evaluate the effects of dietary supplementation with Agaricus sylvaticus fungus on hematological, immunological, and glycemia levels of postsurgical patients with colorectal cancer. Methods: A randomized, placebo-controlled, clinical trial was conducted at the General Hospital of Brazil for 6 months. Fifty-six patients with colorectal cancer (stages I, II, and III) were divided into 2 groups: A. sylvaticus (30 mg/kg/day) and placebo. Complete hemogram, serum iron, and fasting glycemia evaluations were carried out throughout the treatment course. Subjects were divided according to body mass index (BMI), sex, and stage of colorectal cancer. Data were analyzed using SPSS 14.0 programs, Student’s t test, and F statistical test, with P ≤ 0.05 considered significant. Results: After 6 months of supplementation, the group that received A. sylvaticus showed significant increases in hemoglobin ( P = 0.0001), hematocrit ( P = 0.0001), erythrocytes ( P = 0.01), mean cell volume ( P = 0.01), mean cell hemoglobin ( P = 0.0001), mean cell hemoglobin concentration ( P = 0.0001), and neutrophil levels ( P = 0.0001). The platelet count was significantly reduced ( P = 0.03), but remained within normal levels. No significant alterations were observed in the placebo group. The study group was composed of 32 women (57.1%) and 24 men (42.9%). Mean BMI was 24.65 kg/m2. Glycemia levels in the placebo group (average age 59.14 ± 12.95 years) were: initial, 94.36 ± 15.34 mg/dl; 3 months, 98.12 ± 15.54 mg/dl ( P = 0.03); and 6 months, 98.52 ± 9.03 mg/dl ( P = 0.01). Glycemia levels in the supplemented group (average age 56.34 ± 15.53 years) were: initial, 95.92 ± 11.64 mg/dl, 3 months, 94.88 ± 12.24 mg/dl ( P = 0.65); and 6 months, 92.86 ± 6.82 mg/dl ( P = 0.01). Conclusions: The results of this study suggest that supplementation with A. sylvaticus produces benefits in hematological and immunological parameters and can reduce glycemia levels in patients with colorectal cancer.

Determination of reference values for elevated fasting and random insulin levels and their associations with metabolic risk factors among rural Pakistanis from Sindh Province

AIM

To assess insulin levels and their association with metabolic risk factors (family history of diabetes, abnormal glucose tolerance, hypertension, overweight and android obesity) among a representative group of Pakistan.

METHODS

The study data was taken from the database of a population-based survey conducted in Sindh Province, Pakistan, in 1994 to assess the prevalence of diabetes mellitus and impaired glucose tolerance (IGT). Through stratified random sampling; oral glucose tolerance tests were performed in 967 adults; every fifth sample was estimated for fasting and random (2-hour post-75 gm glucose load) insulin levels. The total number of metabolic risk factors was counted for each subject, and their association with insulin levels studied.

RESULTS

Of the 130 subjects, 56.1% were females and 95.4% were Sindhi. The mean age of males and females was 43.84 and 40.61 years, respectively. Family history for diabetes and frequency of overweight had significant positive associations with both fasting and random insulin levels (P < 0.05). Association between hypertension and insulin levels was significant only for random insulin levels, and between android obesity, abnormal glucose tolerance, or male gender and insulin levels only for fasting insulin levels (P < 0.05). Metabolic risk factors had significant positive associations with both fasting (r = 0.351 P = 0.000) as well as random insulin levels (r = 0.364 P = 0.000).

CONCLUSION

This paper provides baseline pioneering information applicable to the Pakistani population. Furthermore, the observations made in this study about differences in association of fasting or random insulin levels with various metabolic risk factors highlight the possibility of using either of them for risk assessment. This finding needs to be assessed in a larger and nationally representative sample.