Metabolic responses to fasting and ethanol infusion in obese, diabetic subjects. Relationship to insulin deficiency

The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia

OBJECTIVES

To evaluate the relationship between metabolic syndrome and annual prostatic growth rates in benign prostatic hyperplasia (BPH) patients.

METHODS

The 78 BPH patients with lower urinary tract symptoms included in this prospective study were divided into two groups according to whether they had a diagnosis of metabolic syndrome. This diagnosis was made according to the most recent consensus report of the National Cholesterol Education Program's Third Adult Treatment Panel. Blood pressure, body weight, body height, and waist and hip circumferences were measured. The body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Biochemical analyses including serum glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), insulin, and prostate-specific antigen (PSA) were performed. Total prostate (TP) volume and transitional zone (TZ) volume were measured by transrectal ultrasound. Annual TP and TZ growth rates were calculated.

RESULTS

BPH patients with metabolic syndrome (first group) had significantly higher median body weight, BMI, serum glucose, serum triglyceride, and PSA levels but lower serum HDL-C level, compared with BPH patients without metabolic syndrome (second group, p<0.05). Median annual TP growth rate (1.0 ml/yr) and median annual TZ growth rate (1.25 ml/yr) were significantly higher in the first group versus the second group (0.64 ml/yr and 0.93 ml/yr, respectively, p<0.05).

CONCLUSIONS

The present study demonstrates a further increase in prostate growth in BPH patients with metabolic syndrome. Future studies are needed to confirm our results and to explain underlying mechanisms.

Effect of 4-methylpyrazole on ethanol-induced decrease in rat plasma amino acids

It has been shown earlier that an acute dose of ethanol causes an immediate decrease in the concentration of most plasma amino acids, and that this decrease involves both beta-adrenergic and adrenocortical mechanisms. In this work is shown that the oxidation of ethanol also plays an important role in the amino acid decreasing effect. Male rats were pretreated with 4-methylpyrazole, an inhibitor of liver alcohol dehydrogenase, in doses causing an 85% inhibition of the ethanol elimination. In this group the ethanol-induced decrease in amino acids was much less pronounced than in a control group pretreated with saline.

The effect of ten days of fasting on various aspects of carbohydrate metabolism in obese diabetic subjects with significant fasting hyperglycemia

Patients with nonketotic diabetes mellitus, who were both obese and had significant fasting hyperglycemia (mean plasma glucose = 310 mg/100 ml), were fasted for 10 days. There was a prompt drop of plasma glucose levels as the result of the caloric deprivation with a mean fall of approximately 200 mg/dl at the end of the fast. The drop in plasma glucose level that occurred during the fast was associated with a drop in plasma insulin level. Fasting plasma glucose concentration rose immediately after food intake was resumed and stabilized within 3--4 days at levels halfway between the initial and the lowest value. At this time, the patients also seemed capable of disposing of an oral glucose load more efficiently. The apparent improvement in carbohydrate homeostasis observed after the fast could not be attributed to an increase in insulin response, but was associated with some amelioration of the insulin resistance that characterizes these patients. Unfortunately, the beneficial effects of the 10-day period of caloric deprivation were transitory and fasting plasma glucose values had returned to prefast levels in most patients within a few months.

Metabolic effects of somatostatin in maturity-onset diabetes

To examine the effects of prolonged infusions of somatostatin in maturity-onset diabetes, we administered five-hour infusions to eight patients. This infusion resulted in a 45 to 55 per cent decline in plasma insulin and glucagon. Plasma glucose initially fell by 20 to 25 mg per 100 ml, but later rose despite continuing hypoglucagonemia. After five hours, plasma glucose concentration was 40 to 50 mg per 100 ml higher than that observed with saline infusion (P less than 0.001). The degree of hyperglycemia and plasma insulin levels correlated inversely at completion of the infusion (P less than 0.01). In addition, somatostatin resulted in a fivefold increase in beta-hydroxybutyrate and a 40 to 45 per cent rise in branched-chain amino acids (P less than 0.005). Our findings suggest that glucagon is not essential for the development and maintenance of fasting hyperglycemia. Furthermore, accentuation by somatostatin of hyperglycemia, hyperketonemia and hyperaminoacidemia in maturity-onset diabetes argues against its use in patients with residual insulin secretion.

Effect of alcohol on fetal cerebral function and metabolism

The effect of maternal alcohol infusions on fetal cerebral function in terms of the electroencephalogram (EEG) and fetal brain metabolism was studied in 10 fetal sheep experiments. A 9.75 per cent alcohol-dextrose solution was infused at the rate of 15 c.c. per kilogram of maternal weight for 1 or 2 hours. Fetal cerebral uptake of oxygen was unaffected. Blood flow was significantly increased as a result of a greater decrease in resistance than decrease in blood pressure. The cerebral uptake of glucose and the glucose-oxygen utilization ratio were significantly increased. The EEG showed a decrease in amplitude and slowing of the dominant rhythm as the blood alcohol concentration increased and became isoelectric on occasion during the postinfusion period associated with a severe fetal acidosis.