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Naik S, Mahalle N, Greibe E, Ostenfeld MS, Heegaard CW, Nexo E, Fedosov SN. Cyano-B12 or Whey Powder with Endogenous Hydroxo-B12 for Supplementation in B12 Deficient Lactovegetarians. Nutrients 2019; 11:nu11102382. [PMID: 31590426 PMCID: PMC6835307 DOI: 10.3390/nu11102382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/31/2022] Open
Abstract
Lactovegetarians (n = 35) with low vitamin B12 (B12) status were intervened for eight weeks capsules containing cyano-B12 (CN-B12), (2 × 2.8 µg/day), or equivalent doses of endogenous B12 (mainly hydroxo-B12 (HO-B12)) in whey powder. Blood samples were examined at baseline, every second week during the intervention, and two weeks post-intervention. The groups did not differ at baseline in [global median (min/max)] plasma B12 [112(61/185)] pmol/L, holotranscobalamin [20(4/99)] pmol/L, folate [13(11/16)], the metabolites total homocysteine [18(9/52)] µmol/L and methylmalonic acid [0.90(0.28/2.5)] µmol/L, and the combined indicator of B12 status (4cB12) [-1.7(-3.0/-0.33)]. Both supplements caused significant effects, though none of the biomarkers returned to normal values. Total plasma B12 showed a higher increase in the capsule group compared to the whey powder group (p = 0.02). However, the increase of plasma holotranscobalamin (p = 0.06) and the lowering of the metabolites (p > 0.07) were alike in both groups. Thereby, the high total plasma B12 in the capsule group was not mirrored in enhanced B12 metabolism, possibly because the B12 surplus was mainly accumulated on an "inert" carrier haptocorrin, considered to be of marginal importance for tissue delivery of B12. In conclusion, we demonstrate that administration of whey powder (HO-B12) or capsules (CN-B12) equivalent to 5.6 µg of B12 daily for eight weeks similarly improves B12 status but does not normalize it. We document that the results for plasma B12 should be interpreted with caution following administration of CN-B12, since the change is disproportionately high compared to the responses of complementary biomarkers.
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Affiliation(s)
- Sadanand Naik
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune, 411004, India.
| | - Namita Mahalle
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune, 411004, India.
| | - Eva Greibe
- Department of Clinical Biochemistry and Institute of Clinical Medicine, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.
| | | | - Christian W Heegaard
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus C, Denmark.
| | - Ebba Nexo
- Department of Clinical Biochemistry and Institute of Clinical Medicine, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.
| | - Sergey N Fedosov
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus C, Denmark.
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Garg MK, Mahalle N. Calcium Supplementation: Why, Which, and How? Indian J Endocrinol Metab 2019; 23:387-390. [PMID: 31741894 PMCID: PMC6844170 DOI: 10.4103/2230-8210.268505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- M. K. Garg
- Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Namita Mahalle
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
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Mahalle N, Bhide V, Greibe E, Heegaard CW, Nexo E, Fedosov SN, Naik S. Comparative Bioavailability of Synthetic B12 and Dietary Vitamin B12 Present in Cow and Buffalo Milk: A Prospective Study in Lactovegetarian Indians. Nutrients 2019; 11:nu11020304. [PMID: 30717112 PMCID: PMC6412291 DOI: 10.3390/nu11020304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/16/2022] Open
Abstract
We assessed improvements in the vitamin B12 status of Indian lactovegetarians receiving four weeks supplementation with natural B12 in milk versus cyano-B12 in capsules. Three groups (n = 22, 23, 22) received daily oral doses of cyano-B12 (2 × 0.76 µg) or milk (2 × 200 mL) from a cow or buffalo (amounting to B12 ≈ 2 × 0.76 µg). Their blood was examined at baseline and each following week. The baselines (median (min/max)) indicated a low B12 status: plasma B12 (116(51/314)) pmol/L, holotranscobalamin (holoTC) (30(7/119)) pmol/L, total homocysteine (Hcy) (24(10/118)) µmol/L, methylmalonic acid (MMA) (0.58(0.15/2.2)) µmol/L and combined B12 index (cB12) (-1.32 - (-3.12/+0.29)). Shifts from the baselines (B12, holoTC, cB12) and ratios to the baselines (Hcy, MMA) were analyzed over time. The cyano-B12 treatment gave more total B12 in plasma at week one (+29 pmol/L, p = 0.004) but showed no further increase. Other biomarkers changed more comparably between the three groups (p ≥ 0.05): holoTC showed a transient spike that leveled off, Hcy finally decreased to 0.8 × baseline, while MMA showed marginal changes. The combined indexes improved comparably (p = 0.6) in all groups (+0.2(-0.3/+0.9), p ≤ 0.002). In conclusion, the tested formulations similarly improved B12 status, but did not normalize it.
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Affiliation(s)
- Namita Mahalle
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune 411004, India.
| | - Vijayshri Bhide
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune 411004, India.
| | - Eva Greibe
- Department of Clinical Biochemistry and Institute of Clinical Medicine, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.
| | - Christian W Heegaard
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus C, Denmark.
| | - Ebba Nexo
- Department of Clinical Biochemistry and Institute of Clinical Medicine, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.
| | - Sergey N Fedosov
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000 Aarhus C, Denmark.
| | - Sadanand Naik
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune 411004, India.
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Abstract
BACKGROUND Obesity has become a global epidemic and it is rising is Asia. Vitamin D deficiency (VDD) is widely prevalent in the Indian subcontinent. Studies have linked VDD to obesity and shown correlation between parathyroid hormone (PTH), 25-hydroxy Vitamin D (25(OH)D), and fat mass (FM). However, studies on the role of PTH among subjects with VDD are lacking. OBJECTIVE The objective of this study is to study the role of PTH in the determination of FM in participants with VDD. SUBJECTS Five hundred and fifty-one adults (m:247, f:304) were included in this study. MATERIALS AND METHODS Total and regional (trunk, arm, and leg) FM was assessed by dual X-ray absorptometry. Biochemical and hormonal parameters such as calcium, phosphorus, alkaline phosphatase, ionic calcium, 25(OH)D, and PTH were also analyzed. RESULTS The mean age of the study population was 58.8 ± 15.8 years (Male: [63.3 ± 13.1], Female: [55.2 ± 16.9]). FM and body mass index were significantly lower in females with higher levels of serum 25(OH)D. Total FM was negatively correlated with serum 25(OH)D (r = -0.363, P < 0.0001) and positively correlated with serum PTH (r: 0.262, P < 0.0001) in females only. Females with VDD and secondary hyperparathyroidism had higher FM than those with normal PTH. CONCLUSIONS Females with VDD had higher total and regional FM. However, this correlation was evident only in those with high serum PTH levels, suggesting a potential role of PTH in the accumulation of FM.
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Affiliation(s)
| | - M. K. Garg
- Departmemt of Endocrinology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Namita Mahalle
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Kuntal Bhadra
- Department of Endocrinology, Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Greibe E, Mahalle N, Bhide V, Heegaard CW, Naik S, Nexo E. Increase in circulating holotranscobalamin after oral administration of cyanocobalamin or hydroxocobalamin in healthy adults with low and normal cobalamin status. Eur J Nutr 2017; 57:2847-2855. [PMID: 29038891 PMCID: PMC6267412 DOI: 10.1007/s00394-017-1553-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 09/30/2017] [Indexed: 12/03/2022]
Abstract
Purpose To investigate the absorption of synthetic cyanocobalamin and natural occurring hydroxocobalamin in populations with low and normal cobalamin (vitamin B12) status. Methods We included adults with low (n = 59) and normal (n = 42) cobalamin status and measured the change in serum holotranscobalamin (ΔholoTC) before and after 2 day administration of different doses of cyanocobalamin and hydroxocobalamin (CobaSorb test). In the low status group, the test was performed using a cross-over design with identical doses of both cobalamin forms (1.5, 3, and 6 µg, respectively). In the normal status group, the test was performed with either 3, 6, and 9 µg cyanocobalamin (n = 28), or with 9 µg cyanocobalamin and 9 µg hydroxocobalamin (n = 14). Results In both groups, median ΔholoTC (pmol/L) was higher after intake of cyanocobalamin compared to (hydroxocobalamin) [low status: 1.5 µg: 19 (6); 3 µg: 23 (7); 6 µg: 30 (14); normal status: 9 µg: 30 (13) pmol/L]. Independent of B12 form, no difference was observed in ΔholoTC between those receiving 1.5 and 3 µg in the low status group or 6 and 9 µg cyanocobalamin in the normal status group. However, in both groups, administration of 6 µg cobalamin resulted in a significant higher ΔholoTC than did 3 µg [low status: p = 0.02 (0.009) for cyanocobalamin (hydroxocobalamin); normal status: p = 0.03 for cyanocobalamin]. Conclusions Administration of cyanocobalamin resulted in a more than twofold increase in holoTC in comparison with hydroxocobalamin. The absorptive capacity was reached only by doses above 3 µg cobalamin. Our results underscore the importance of using the same form of cobalamin when comparing uptake under different conditions. Clinical trial registry number NCT02832726 at https://clinicaltrials.gov and 2016/09/012147 at Clinical Trials Registry India. Electronic supplementary material The online version of this article (doi:10.1007/s00394-017-1553-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Greibe
- Department of Clinical Biochemistry and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Namita Mahalle
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Vijayshri Bhide
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Christian W Heegaard
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Sadanand Naik
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
- Clinical Biochemistry, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
| | - Ebba Nexo
- Department of Clinical Biochemistry and Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Marwaha RK, Garg MK, Bhadra K, Mahalle N, Mithal A, Tandon N. Lean body mass and bone health in urban adolescents from northern India. Indian Pediatr 2017; 54:193-198. [DOI: 10.1007/s13312-017-1029-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND The association of obesity and lean mass (LM) has not been examined well in children and adolescents, and it remains controversial. OBJECTIVE The objective of this study was to evaluate the relationship of body mass index (BMI) categories and regional obesity with total and regional LM in children and adolescents. METHODS A total of 1408 children and adolescents (boys 58.9%; girls 41.1%) divided according to BMI (normal weight 79.5%, overweight 16.0%, and obese 4.5%) were included in this cross-sectional study. Total and regional LM and fat mass were measured by DXA. Leg and arm fat-to-total fat ratio (LATR) indicative of subcutaneous fat and trunk fat-to-total fat ratio (TTR), an indicator of visceral fat, were calculated. RESULTS Mean age of the study population was 13.2 ± 2.7 years (boys - 13.0 ± 2.7; girls - 13.4 ± 2.8 years). Total LM (TLM) and its regional distribution were higher in overweight and obese groups when compared with those with normal BMI in both genders. TLM was comparable between overweight and obese in both genders. TLM per unit of fat progressively decreased from normal to obese categories. The difference in LM per unit fat between BMI categories persisted after adjustment for age, height, and sexual maturity score. TLM increased across the quartiles of TTR, but decreased with an increment in subcutaneous fat (quartiles of LATR). CONCLUSIONS Obese children and adolescents apparently have higher LM than normal BMI children, but have lower LM per unit of fat. Subcutaneous fat had a negative impact and visceral fat had a positive impact on TLM.
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Affiliation(s)
- M. K. Garg
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Raman K. Marwaha
- Senior Consultant Endocrinology and Scientific Advisor (Projects), ILSI-India, New Delhi, India
| | - Namita Mahalle
- Department of Pathology, Biochemistry Division, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Mahalle N, Garg M, Naik S, Kulkarni M. Association of dietary factors with severity of coronary artery disease. Clin Nutr ESPEN 2016; 15:75-79. [DOI: 10.1016/j.clnesp.2016.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 02/05/2023]
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Marwaha RK, Garg MK, Bhadra K, Mahalle N, Mithal A, Tandon N. Assessment and relation of total and regional fat mass with bone mineral content among Indian urban adolescents. J Pediatr Endocrinol Metab 2015; 28:1085-93. [PMID: 25968429 DOI: 10.1515/jpem-2014-0281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 03/06/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fat mass (FM) has been shown to have an effect on bone mass accrual. Though gender and ethnic differences in body composition and bone accrual during puberty have been reported, there are limited data available for Indian children and adolescents. OBJECTIVE To generate age and gender based percentile charts of FM among urban Indian children and adolescents and to evaluate the relationship with pubertal status and bone mineral content (BMC). SUBJECTS There were 1403 children and adolescents (boys: 826; girls: 577) in the study. METHODS Total and regional FM, BMC, and pubertal staging were assessed. Fat mass index (FMI), FM/height ratio and BMC/FM ratio, were calculated. RESULTS The age of the study population ranged from 5 to 18 years, with a mean age of 13.2 ± 2.7 years (boys: 13.0 ± 2.7; girls: 13.4 ± 2.8 years). Total and regional FM as well as FMI increased with increasing age in both genders. The highest percent increase in mean total FM occurred in the age group > 8-11 years and decreased thereafter. The total and regional FM was higher in more advanced stages of pubertal maturation. There was no difference in total and regional FM between genders in prepubertal group. The age and pubertal associated increase in FM was significantly higher in girls than boys (p < 0.0001). Total as well as regional FM and FMI were positively correlated with age, body mass index, total lean mass, and BMC even after adjusting for age, lean mass, and biochemical parameters. CONCLUSIONS Total and regional FM increased with age and pubertal maturation in both genders. FM was positively correlated with BMC.
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Marwaha RK, Garg MK, Tandon N, Mahalle N. Comparison of body composition between professional sportswomen and apparently healthy age- and sex-matched controls. Indian J Endocrinol Metab 2015; 19:288-291. [PMID: 25729694 PMCID: PMC4319272 DOI: 10.4103/2230-8210.149323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In view of the relationship between physical activity and nutrition on body composition, we assessed lean and fat mass and BMC (total and regional) in professional Indian sportswomen and compared it with apparently healthy age- and sex-matched females. MATERIALS AND METHODS This cross-sectional study included 104 sportswomen and an equal number of age-matched normal healthy females (controls). They were evaluated for anthropometry and body composition (fat, lean mass, and bone mineral content (BMC) by DXA. RESULTS Mean age (19.1 ± 1.3 vs. 19.4 ± 1.5 years) and body mass index (21.34 ± 3.02 vs. 21.26 ± 4.05 kg/m(2)) were comparable in both groups. Sportswomen had higher intake of energy, macronutrients, calcium, phosphorus and magnesium. Total lean mass (33.67 ± 3.49 vs. 31.14 ± 3.52 kg, P < 0.0001), appendicular skeletal muscle index (5.84 ± 0.57 vs. 5.46 ± 0.63 kg/m(2); P < 0.0001) and BMC (2.27 ± 0.32 vs. 2.13 ± 0.34 kg, P < 0.002) was significantly higher and percentage fat mass was significantly lower (33.1 ± 7.5 vs. 37.0 ± 8.3; P < 0.0001) among sportswomen when compared to controls. CONCLUSIONS Indian sportswomen have a higher total and regional lean mass, BMC, and lower percentage fat mass when compared with healthy females. Physical activity, energy, protein and calcium intake were positively associated with lean mass and BMC.
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Affiliation(s)
| | - M. K. Garg
- Department of Endocrinology and Metabolism, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Namita Mahalle
- Department of Pathology, Biochemistry Division, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, Maharashtra, India
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Mahalle N, Garg M, Kulkarni M, Naik S. Association of Inflammatory Cytokines with Traditional and Nontraditional Cardiovascular Risk Factors in Indians with known Coronary Artery Disease. Ann Med Health Sci Res 2014; 4:706-12. [PMID: 25328779 PMCID: PMC4199160 DOI: 10.4103/2141-9248.141525] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Inflammatory processes are implicated in the etiology of cardiovascular disease (CVD). Data on the association of inflammatory markers with cardiovascular risk factors in Indian patients with CVD are limited. AIM This study was conducted with the aim to evaluate the association of inflammatory markers with traditional and nontraditional cardiovascular risk factors in angiographically proven coronary artery disease (CAD) patients. SUBJECTS AND METHODS We studied the association of serum highly sensitive C-reactive protein (hsCRP) (0.1-37.9 mg/l), interleukin-6 (IL-6) (2-253.2 pg/ml) and tumor necrosis factor-alpha (TNF-α) (8-525.8 pg/ml) with cardiovascular risk factors in 300 (M: 216, F: 84; mean age: 60.9 (12.4) years) CAD patients. All patients were evaluated for anthropometry and cardiovascular risk factors, and blood samples were collected for biochemical and inflammatory markers. Statistical analysis was carried out using SPSS Version 20. RESULTS Mean hsCRP, IL-6 and TNF-α in study population were 11.7 (9.7) mg/l, 64.5 (75.2) pg/ml, and 25.3 (40.9) pg/ml respectively. A total of 73.6% (221/300) patients had hsCRP levels >3.0 mg/l. All inflammatory markers were significantly higher and showed a positive correlation with dyslipidemia, diabetes mellitus, and/or hypertension (HTN). TNF-α had a negative correlation with age and positive correlation with smoking. Only IL-6 and hsCRP had a positive correlation with insulin resistance and negative correlation with insulin secretion. Among lipid parameters, triglyceride had a positive correlation, and high density lipoprotein had a negative correlation with all inflammatory markers. There was a progressive increase in the percentage of subjects with diabetes, HTN, and dyslipidemia with increasing levels of inflammatory markers. CONCLUSIONS Indian patients with CAD had significantly high levels of inflammatory markers, which were related to cardiovascular risk factors.
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Affiliation(s)
- N Mahalle
- Department of Pathology, Biochemistry Section, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
| | - Mk Garg
- Department of Endocrinology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Mv Kulkarni
- Department of Chemistry, Division of Biochemistry, University of Pune, Pune, Maharashtra, India
| | - Ss Naik
- Department of Pathology, Biochemistry Section, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
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Abstract
BACKGROUND South Asians are more prone to develop metabolic syndrome (MetS). The additive predictive value of components of MetS for cardiovascular diseases is still debated. We undertook this study to evaluate the association of MetS and its components with severity of coronary artery disease (CAD). MATERIALS AND METHODS Three hundred patients with known coronary disease above the age of 25 years were included in this study. Blood samples were collected for biochemical markers. Patients were stratified into subjects with and without MetS (International Diabetes Federation, IDF, criteria) and severity of CAD (number of vessel involved). RESULTS Mean age of the patient in the study was 60.9 ± 12.4 years (male, M: 72%; female, F: 28%). MetS was present in 64% patients. Patients with MetS had more severe CAD compared to those without MetS. Triple vessel disease (TVD) was present in 62.5% of patients with MetS compared to 34.3% among without MetS (P < 0.0001). The percent number of patients with TVD showed increasing trend with increasing number of components of MetS (0-0%; 1-20%; 2-27.5%; 3-47.8%; 4-72.6%; 5-78.3%; Chi square for trend < 0.0001). Inflammatory markers [interleukin (IL) 6: 77.67 ± 79.48 vs. 41.21 ± 60.72 pg/ml, P < 0.0001; tumor nuclear factor (TNF)-α: 28.0 ± 47.49 vs 20.43 ± 24.5 pg/ml, P < 0.0001; high sensitive C-reactive protein (hsCRP): 14.30 ± 9.91 vs. 7.02 ± 7.18 mg/L, P < 0.0001], insulin resistance [homeostatic model analysis insulin resistance (HOMA-IR): 22.33 ± 23.37 vs. 10.86 ± 13.90, P < 0.0001] were higher and insulin sensitivity [quantitative insulin check index (QUICKI): 0.26 ± 0.03 vs. 0.30 ± 0.04, P < 0.0001] was significantly lower in subjects with MetS compared to subjects without MetS. Among lipids, total cholesterol were comparable but triglyceride (175 ± 42 vs. 179 ± 48 vs. 180 ± 47 mg/dl, P < 0.0001) was high and high-density lipoprotein (HDL; 44.72 ± 7.63 vs. 39.96 ± 8.70 vs. 36.05 ± 8.84, P < 0.0001) was low in subjects with TVD compared to others. Similarly, percentage of patients with diabetes (7.5% vs. 26.3% vs. 63.7%, P < 0.0001) and hypertension (34.3% vs. 56.6% vs. 77.7%, P < 0.0001) were higher in subjects with TVD compared to others. CONCLUSIONS There is a strong correlation of MetS and its components with severity of CAD.
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Affiliation(s)
- Namita Mahalle
- Department of Pathology, Biochemistry Section, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - M. K. Garg
- Commandant and Consultant, Medicine and Endocrinology, Military Hospital, Shillong, Meghalaya, India
| | - Sadanand S. Naik
- Department of Pathology, Biochemistry Section, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Mohan V. Kulkarni
- Department of Chemistry, Division of Biochemistry, University of Pune, Pune, Maharashtra, India
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Mahalle N, Kulkarni MV, Naik SS, Garg MK. Association of dietary factors with insulin resistance and inflammatory markers in subjects with diabetes mellitus and coronary artery disease in Indian population. J Diabetes Complications 2014; 28:536-41. [PMID: 24746438 DOI: 10.1016/j.jdiacomp.2012.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/10/2012] [Accepted: 09/19/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insulin resistance (IR) and inflammation have been implicated in pathogenesis of diabetes and cardiovascular disease. Dietary factors have been reported to be associated to insulin resistance and inflammation. Hence, we studied the association of dietary factors with IR and inflammation in known patients with diabetes mellitus and coronary artery disease with the hypothesis that carbohydrate and fat will be positively; and protein, fiber and mineral will be negatively associated with IR and inflammatory markers. METHODS Three hundred patients (M: 216; F: 84, age: 25-92) who had coronary disease on angiography were included in this study consecutively. All patients were evaluated for anthropometry and cardiovascular risk factors, and blood samples were collected for biochemical and inflammatory markers. Nutrition assessment was done once at the time of recruitment, based on 24h dietary recall. RESULTS AND CONCLUSIONS Diabetic patients had significantly lower protein and total dietary fiber intake as compared to non diabetics. Diabetic patients had lower intake of vitamin A, riboflavin and vitamin B12. There was significantly lower intake of minerals by diabetic patients. Dietary carbohydrate and fat were positively, and protein and dietary fiber intakes were negatively correlated with HOMA-IR and IL-6. There was no correlation of individual amino acids with HOMA-IR but showed strong negative correlation with inflammatory markers (hsCRP; IL-6 and TNF-α). Intake of vitamins and minerals was negatively correlated with HOMA-IR and inflammatory markers. There is a strong correlation between dietary factors, insulin resistance and inflammatory markers.
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Affiliation(s)
- N Mahalle
- Deenanath Mangeshkar Hospital and Research Center, Biochemistry Section, Department of Pathology, Erandawane, Pune-411004, India; Department of Endocrinology, Command Hospital (Southern Command), Pune.
| | - M V Kulkarni
- Division of Biochemistry, Department of Chemistry, University of Pune
| | - S S Naik
- Deenanath Mangeshkar Hospital and Research Center, Biochemistry Section, Department of Pathology, Erandawane, Pune-411004, India; Department of Endocrinology, Command Hospital (Southern Command), Pune
| | - M K Garg
- Department of Endocrinology, Command Hospital (Southern Command), Pune
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Abstract
INTRODUCTION Cardiovascular disease and osteoporosis share common risk factors including dyslipidemia. There are conflicting reports of differential relation of various lipid parameters on bone mineral density (BMD). Hence, we studied the correlation between lipid parameters and BMD in healthy adult. MATERIALS AND METHODS A total of 2347 participants (male 39.4%; female 60.6%) included in this cross-sectional study were divided according to sex and age. Fasting blood samples were drawn for biochemical parameters. BMD at lumbar spine, femur, and forearm were measured by dual energy X-ray absorptiometry (DXA). RESULTS In males, BMD at femur and lumbar spine decreased significantly with increasing quartiles of total cholesterol (TC) (P < 0.0001, and 0.004) and low-density lipoprotein cholesterol (LDL-c) (P = 0.001, and 0.01). In premenopausal women, BMD at femoral neck (P = 0.001) and lumbar spine (P = 0.029) showed declining trend with LDL-c (P = 0.007). In postmenopausal women, only BMD at total femur decreased significantly with TC (P = 0.024) and LDL-c (P = 0.036). All above findings were confirmed in correlation studies. In multiple regression analysis after adjusting for age, body mass index, ionized calcium, alkaline phosphatase, 25 hydroxy vitamin D, and parathyroid hormone levels correlation of BMD with TC and LDL-c persisted. TC, LDL-c was higher in subjects with low bone density compared those with normal bone density in both sexes. CONCLUSIONS TC and LDL-c had weak but significant negative correlation with BMD at femur and lumbar spine.
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Affiliation(s)
- M. K. Garg
- Department of Endocrinology and Metabolism, Command Hospital (Southern Command), Pune, Maharastra, India
| | - Raman K. Marwaha
- Department of Endocrinology and Metabolism, International Life Sciences Institute-India, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Kuntal Bhadra
- Department of Endocrinology and Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - N. Mahalle
- Department of Pathology, Biochemistry Division, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, Maharashtra, India
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Garg MK, Mahalle N, Kalra S. Redefining vitamin D deficiency: Reply to comments. Indian J Endocrinol Metab 2014; 18:247. [PMID: 24741530 PMCID: PMC3987284 DOI: 10.4103/2230-8210.129125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- MK Garg
- Department of Medicine and Endocrinology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - N Mahalle
- Biochemistry Section, Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, India
| | - Sanjay Kalra
- Bharti Hospital and BRIDE, Karnal, Haryana, India
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Garg MK, Tandon N, Marwaha RK, Menon AS, Mahalle N. The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population. Clin Endocrinol (Oxf) 2014; 80:41-6. [PMID: 23682759 DOI: 10.1111/cen.12248] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Vitamin D deficiency (VDD) is a global problem. Not all patients with VDD have clinical manifestations or secondary hyperparathyroidism. We studied the interaction between serum 25-hydroxy vitamin D (25OHD), parathormone (PTH) and bone mineral density (BMD) in Indian adolescents and adults. DESIGN Population survey. PATIENTS A total of 1829 adolescents and 1346 adults aged 50 years and above were analysed in this study. MEASUREMENTS Serum biochemistry, 25OHD, PTH and BMD were estimated. Subjects were grouped according to quartiles of serum PTH. VDD was defined as severe (25OHD ≤ 5 ng/ml), moderate (25OHD ≤ 10 ng/ml) and mild (25OHD ≤ 20 ng/ml) and secondary hyperparathyroidism (SHPT) when serum PTH levels >65 pg/ml. RESULTS Only 30-40% of subjects with moderate and severe VDD, respectively, had SHPT. BMD decreased from Quartile 1 to Quartile 4 of PTH at all sites among adolescents and adults, with only a marginal decline in serum 25OHD levels between these quartiles. Further, within each PTH quartile, there was no difference in BMD according to categories of VDD. Analysing BMD in the different PTH quartiles, the PTH cut-offs beyond which BMD showed a significant decline, was 35 pg/ml in adolescents and 53 pg/ml in adults. CONCLUSIONS Less than half of the subjects with VDD have SHPT. BMD levels start to decline at PTH values currently considered to be normal. These data suggest the need to redefine SHPT in different age groups keeping in mind the relationship between PTH and BMD. This may also influence the decision to supplement subjects with VDD.
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Affiliation(s)
- M K Garg
- Department of Endocrinology and Metabolism, Command Hospital (Southern Command), Pune, Maharashtra, India
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Mahalle N, Garg MK, Naik SS, Kulkarni MV. Study of pattern of dyslipidemia and its correlation with cardiovascular risk factors in patients with proven coronary artery disease. Indian J Endocrinol Metab 2014; 18:48-55. [PMID: 24701430 PMCID: PMC3968733 DOI: 10.4103/2230-8210.126532] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Dyslipidemia is a primary, widely established as an independent major risk factor for coronary artery disease (CAD). Asians differs in prevalence of various lipid abnormalities than non-Asians. Hence, this study was conducted with objective to evaluate the lipid abnormalities and there correlation with traditional and non-traditional risk factors in known subjects with CAD. MATERIALS AND METHODS We studied the pattern and association of dyslipidemia with cardiovascular risk factors in 300 (Male: 216; Female: 84, age: 60.9 ± 12.4 years, range: 25-92 years) angiographically proved CAD patients. All patients were evaluated for anthropometry and cardiovascular risk factors and blood samples were collected for biochemical and inflammatory markers. RESULTS Hypercholesterolemia, hypertriglyceridemia and low high density lipoprotein (HDL) was present in 23.3%, 63.0% and 54.6% in the total study population respectively. A total of 41.3% had atherogenic dyslipidemia (raised triglycerides [TG] and low HDL). Percentage of patients with type-2 diabetes mellitus and hypertension were higher in subjects with atherogenic dyslipidemia. Insulin sensitivity was low; insulin and insulin resistance (IR) along with inflammatory markers were high in subjects with atherogenic dyslipidemia. Patients with atherogenic dyslipidemia had significantly lower serum vitamin B12 levels and higher homocysteine (Hcy) levels. Hypertriglyceridemia was positively correlated with insulin, homeostasis model assessment of IR, Hcy, interleukin-6, Tumor necrosis factor-alpha, highly sensitive C-reactive protein and negatively with vitamin B12 and quantitative insulin check index and an opposite correlation of all quoted parameters was observed with low HDL. The correlation of traditional and non-traditional risk factors was stronger with low HDL and high TG compared with hypercholesterolemia. CONCLUSIONS Hypertriglyceridemia and low HDL cholesterol is common in patients with CAD compared with hypercholesterolemia. This suggests that different preventive strategy is required in Indian patients with CAD.
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Affiliation(s)
- Namita Mahalle
- Department of Pathology, Biochemistry Section, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, Maharashtra, India
| | - M. K. Garg
- Department of Endocrinology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Sadanand S. Naik
- Department of Pathology, Biochemistry Section, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, Maharashtra, India
| | - Mohan V. Kulkarni
- Department of Chemistry, Division of Biochemistry, University of Pune, Pune, Maharashtra, India
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Affiliation(s)
- M. K. Garg
- Department of Endocrinology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Namita Mahalle
- Biochemistry Division, Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, Maharashtra, India
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Affiliation(s)
- M. K. Garg
- Department of Endocrinology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Namita Mahalle
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, Maharashtra, India
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Garg M, Mahalle N. Calcium homeostasis, and clinical or subclinical vitamin D deficiency – Can a hypothesis of “intestinal calcistat” explain it all? Med Hypotheses 2013; 81:253-8. [DOI: 10.1016/j.mehy.2013.04.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/17/2013] [Indexed: 01/25/2023]
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Mahalle N, Kulkarni MV, Garg MK, Naik SS. Vitamin B12 deficiency and hyperhomocysteinemia as correlates of cardiovascular risk factors in Indian subjects with coronary artery disease. J Cardiol 2013; 61:289-94. [PMID: 23473764 DOI: 10.1016/j.jjcc.2012.11.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/06/2012] [Accepted: 11/29/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Folate and vitamin B12 are essential components in the metabolism of homocysteine (Hcy). Hyperhomocysteinemia has been implicated in endothelial dysfunction and cardiovascular disease. However, the association of Hcy, vitamin B12, and folic acid with cardiovascular risk factors in patients with coronary artery disease (CAD) has not been studied in Indian patients. This study was conducted with the aim to evaluate the relationship of vitamin B12, folic acid, and Hcy levels with cardiovascular risk factors in subjects with known CAD. METHODS AND SUBJECTS Three hundred patients (216 men; 84 women; aged 25-92 years) who had CAD on angiography were included in this study consecutively. All patients were evaluated for anthropometry and cardiovascular risk factors, and blood samples were collected for biochemical, nutritional, and inflammatory markers. RESULTS Percentage of vitamin B12 and folate deficiency was 86.7% and 2.7%, respectively. Hyperhomocysteinemia was present in 95.3% patients. Vitamin B12 levels were significantly lower and Hcy levels were significantly higher in subjects with dyslipidemia, DM, and/or hypertension. Serum vitamin B12 was inversely associated with triglyceride and very low-density lipoprotein (VLDL) and positively with high-density lipoprotein (HDL). Hcy was positively associated with triglyceride and VLDL and negatively with HDL. Vitamin B12 was inversely correlated with inflammatory markers (high-sensitivity C-reactive protein and interleukin-6) directly related to insulin resistance whereas Hcy showed the opposite pattern. CONCLUSIONS Serum vitamin B12 deficiency and hyperhomocysteinemia are related with cardiovascular risk factors in Indian patients with CAD.
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Affiliation(s)
- Namita Mahalle
- Deenanath Mangeshkar Hospital and Research Center, Biochemistry Section, Department of Pathology, Erandawane, Pune, India.
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Abstract
Introduction: Magnesium is an essential element that has numerous biological functions in the cardiovascular system. Hence, three hundred patients with known cardiovascular disease above the age of 25 years were studied to evaluate association between dietary and serum magnesium with cardiovascular risk factors. Materials and Methods: Patients were divided into three groups according to serum magnesium levels; ≤1.6 (Group 1), >1.6-2.6 (Group 2) and: >2.6 mg/dl (Group 3), and into two groups according to dietary magnesium intake; ≤350 mg/day (Group 1) and >350 mg/day (Group 2), respectively. Results: Mean age of patients was 60.97 ± 12.5 years. Total cholesterol, triglycerides, VLDL, and LDL were significantly higher and HDL cholesterol significantly lower in group 1 when compared with group 2 and group 3. Diabetes, dyslipidemia, and hypertension were negatively correlated with serum magnesium levels; which were maintained even after adjustment with age, sex, and anthropometric parameters in multiple regression analysis. Similar observations were observed in dietary magnesium intake except LDL and total cholesterol. Dietary magnesium was positively correlated with serum magnesium. Conclusions: Hypomagnesaemia and low dietary intake of magnesium are strongly related to cardiovascular risk factors among known subjects with coronary artery disease. Hence, magnesium supplementation may help in reducing cardiovascular disease.
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Affiliation(s)
- Namita Mahalle
- Department of Pathology, Biochemistry Section, Deenanath Mangeshkar Hospital and Research Center, Erandawane, Pune, India
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Abstract
BACKGROUND The clustering of cardiovascular risk factors is termed the metabolic syndrome (MS), which strongly predicts the risk of diabetes and cardiovascular disease (CVD). Adipokines may contribute to the development of obesity and insulin resistance and may be a causal link between MS, diabetes and CVD. Hence, we studied the adipokines - adiponectin and plasminogen activator inhibitor-1 (PAI-1) - in subjects with MS. MATERIALS AND METHODS We studied 50 subjects with MS diagnosed by International Diabetes Federation (IDF) criteria and 24 healthy age- and sex-matched controls. Clinical evaluation included anthropometry, body fat analysis by bioimpedance, highly sensitive C-reactive protein, insulin, adiponectin, and PAI-1 measurement. RESULTS Subjects with MS had lower adiponectin (4.01 ± 2.24 vs. 8.7 ± 1.77 μg/ml; P < 0.0001) and higher PAI-1 (53.85 ± 16.45 vs. 17.35 ± 4.45 ng/ml; P < 0.0001) levels than controls. Both were related with the number of metabolic abnormalities. Adiponectin was negatively and PAI-1 was positively associated with body mass index, waist hip ratio (WHR), body fat mass, percent body fat, and all the parameters of MS, except HDL where the pattern reversed. WHR and triglycerides were independent predictors of adipokines in multiple regression analysis. Receiver operating characteristic curve analysis showed that adiponectin (6.7 μg/ml) and PAI-1 (25.0 ng/ml) levels predicted the MS with high sensitivity, specificity and accuracy in Indian population. CONCLUSIONS Subjects with MS have lower adiponectin and higher PAI-1 levels compared to healthy controls. Lifestyle measures have been shown to improve the various components of MS, and hence there is an urgent need for public health measures to prevent the ongoing epidemic of diabetes and CVD.
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Affiliation(s)
- M. K. Garg
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India
| | - M. K. Dutta
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India
| | - Namita Mahalle
- Department of Pathology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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Abstract
INTRODUCTION The clustering of cardiovascular risk factors is termed the metabolic syndrome (MS), which strongly predict risk of diabetes and cardiovascular disease. Many studies implicate insulin resistance (IR) in the development of diabetes, but ignore the contribution of beta-cell dysfunction. Hence, we studied beta-cell function, as assessed by HOMA model, in subjects with MS. MATERIALS AND METHODS We studied 50 subjects with MS diagnosed by IDF criteria and 24 healthy age- and sex-matched controls. Clinical evaluation included anthropometry, body fat analysis by bioimpedance, biochemical, and insulin measurement. IR and secretion were calculated by HOMA model. RESULTS Subjects with MS had more IR (HOMA-IR) than controls (3.35 ± 3.14 vs. 1.76 ± 0.53, P = 0.029) and secreted less insulin (HOMA-S) than controls (66.80 ± 69.66 vs. 144.27 ± 101.61, P = 0.0003), although plasma insulin levels were comparable in both groups (10.7 ± 10.2 vs. 8.2 ± 2.38, P = 0.44). HOMA-IR and HOMA-S were related with number of metabolic abnormalities. HOMA-IR was positively associated with body mass index, waist hip ratio, body fat mass, and percent body fat. HOMA-S was negatively associated with waist hip ratio, fasting plasma glucose and total cholesterol and positively with basal metabolic rate. Percent body fat was an independent predictor of HOMA-IR and waist hip ratio of HOMA-S in multiple regression analysis. CONCLUSIONS Subjects with MS have increased IR and decreased insulin secretion compared with healthy controls. Lifestyle measures have been shown to improve IR, insulin secretion, and various components and effects of MS. Hence, there is an urgent need for public health measures to prevent ongoing epidemic of diabetes and cardiovascular disease.
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Affiliation(s)
| | - M. K. Dutta
- Departments of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt – 110010, India
| | - Namita Mahalle
- Departments of Pathology, Deenanath Mangeshkar Hospital, Pune, India
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