Glycated hemoglobin as an option in screening for metabolic syndrome

Összefoglaló. Bevezetés: A metabolikus szindróma előfordulása és jelentősége az elhízás prevalenciájával arányosan megnövekedett. Diagnosztizálása különböző kritériumrendszerek segítségével történhet. Célkitűzés: A kutatás célkitűzése volt egy hátrányos helyzetű település lakosságánál a metabolikus szindróma prevalenciájának megállapítása a diabetes mellitus szempontjából fokozott, illetve magas kockázatú egyéneknél, emellett a glikált hemoglobin alkalmazhatóságának vizsgálata a metabolikus szindróma szűrésében. Módszer: A metabolikus szindróma megállapítása az International Diabetes Federation kritériumrendszere alapján történt a vérnyomás- és haskörfogatértékek, illetve vénás vérminta alapján. Az utóbbi folyamán szérumból a lipidparaméterek és a glikált hemoglobin vizsgálata, plazmából pedig éhomi és terheléses vércukorvizsgálat történt. A labordiagnosztikai módszerek alkalmazhatóságát "receiver-operating characteristic (ROC) curve" (vevőegység-működési karakterisztikus görbe) segítségével elemeztük. Eredmények: A 74 vizsgált egyén 71,62%-ánál igazolódott metabolikus szindróma (n = 53). A legideálisabb "cut-off point" az 5,65%-os (38,3 mmol/mol) glikálthemoglobin-érték volt, amelynél a szenzitivitás 69,8%-nak, míg a specificitás 77,3%-nak (p<0,001) adódott. A módszer pozitív prediktív értéke 69,8%, míg negatív prediktív értéke 81,8% (p<0,001) volt. Az éhomi vércukorszint esetében a legideálisabb vágópontnak szintén az 5,65 mmol/l-es vércukorérték bizonyult. Következtetés: A metabolikus szindróma előfordulása a fokozott, illetve magas diabetesrizikóval rendelkezők körében jelentősen magasabb volt, mint hasonló kutatások esetében az összpopulációra vonatkoztatva. Elemzéseink alapján a glikált hemoglobin a metabolikus szindróma megállapítása során alkalmazható az éhomi vércukorszint kiegészítéseként. Orv Hetil. 2021; 162(31): 1244-1251.

SUMMARY

INTRODUCTION

The incidence and thus the relevance of metabolic syndrome have been increasing in parallel with the prevalence of obesity. Metabolic syndrome can be diagnosed using various criteria systems.

OBJECTIVE

This research was designed to establish the prevalence of metabolic syndrome among patients at moderate or high risk for diabetes mellitus in the population of a disadvantaged Hungarian municipality. The secondary objective of the study was the examination of the suitability of glycated hemoglobin as a screening tool for metabolic syndrome.

METHOD

Diagnosis of metabolic syndrome was established using the International Diabetes Federation criteria system based on the measurement of blood pressure and abdominal circumference as well as values using venous blood samples. Lipid parameters and glycated hemoglobin levels were measured from serum as well. The fasting and two-hours post-load blood glucose were measured from plasma. The validity of the laboratory diagnostic methods were determined with receiver-operating characteristic (ROC) curve analysis.

RESULTS

71.62% of the 74 tested patients were confirmed to have metabolic syndrome (n = 53). The optimal cut-off point was 5.65% (38.3 mmol/mol) glycated hemoglobin value with 69.8% sensitivity and 77.3% specificity (p<0.001). The positive predictive value of the method was 69.8%, while the negative predictive value was 81.8% (p<0.001). For fasting glucose levels, the optimal cut-off point was the 5.65 mmol/L blood glucose level.

CONCLUSION

The prevalence of metabolic syndrome among individuals at elevated or high risk for diabetes was significantly higher compared to the total population, based on published data from similar earlier studies. Based on our analyses, glycated hemoglobin - used as a complementary parameter to fasting glucose level - is suitable for the diagnosis of metabolic syndrome. Orv Hetil. 2021; 162(31): 1244-1251.

Insulin resistance and its effects in children and adolescents

Összefoglaló. Számos adat igazolja, hogy az inzulinrezisztencia gyakori jelenség gyermek- és serdülőkorban, és szoros kapcsolatban áll a cardiovascularis kockázat növekedésével, ami miatt a kérdéskörre az életnek ebben a korai szakaszában is kiemelt figyelmet kell fordítani. Ma már egyre több ismerettel rendelkezünk a kockázati tényezőket illetően, nincs azonban egységes álláspont az inzulinrezisztencia meghatározására vonatkozóan a klinikai gyakorlatban, és nem rendelkezünk megfelelő laboratóriumi markerekkel, melyek segítségével a veszélyeztetetteket széles körben eredményesen lehetne azonosítani. Mindezek alapján a laboratóriumi módszerrel történő szűrés ebben az életkorban nem indokolt, azonban a társuló és következményes kórállapotok klinikai alapon történő felismerésére törekedni kell. A cardiovascularis kockázat megelőzésére irányuló életmódbeli prevenció hatásos az inzulinrezisztencia csökkentésében, a gyakorlatban azonban kivitelezése és eredményessége korlátozott. A gyógyszeres intervenció jelenleg ebben az életkorban csak egyes szelektált esetekben kerülhet alkalmazásra. További klinikai kutatásokra van szükség az inzulinrezisztencia mérése, az életmódbeli és gyógyszeres intervenciós lehetőségek területén annak érdekében, hogy sikeres stratégiák legyenek kialakíthatók a cardiovascularis halálozás megelőzése, csökkentése érdekében. Orv Hetil. 2021; 162(11): 403-412. Summary. Numerous data confirm that insulin resistance is a common phenomenon in children, and closely links to an increase in cardiovascular risk, therefore it is urgent to pay attention to this from early childhood. Today, we have more and more knowledge about risk factors, but there is no common position on the definition of insulin resistance in clinical practice and we do not have adequate laboratory markers to identify those at risk effectively. Based on all these factors, laboratory screening is not justified at this age, however, efforts should be made to recognize associated and consequent conditions on a clinical basis. Lifestyle prevention to prevent cardiovascular risk is effective in reducing insulin resistance, but in practice its implementation and effectiveness are limited. At present, pharmacological intervention can only be used in certain selected cases with this age group. Further clinical research is needed to measure insulin resistance, lifestyle and drug intervention options in order to develop successful strategies to prevent and reduce cardiovascular death. Orv Hetil. 2021; 162(11): 403-412.

Metabolic consequences of chronic obstructive pulmonary disease

Összefoglaló. Bevezetés: Krónikus obstruktív tüdőbetegségben (COPD) az obesitas mellett a csökkent fizikai aktivitás nagymértékben fokozza a metabolikus szindróma kialakulásának valószínűségét. Célkitűzés: Kutatásunk célja volt felmérni a metabolikus szindróma prevalenciáját COPD-ben, valamint azt, hogy milyen mértékben függ össze az életkorral, a nemmel, a társbetegségekkel, a tüdőfunkció károsodásának mértékével, a tápláltsági állapottal, a fizikai terhelhetőséggel és az életminőséggel. Módszer: Keresztmetszeti vizsgálatot végeztünk az Országos Korányi Pulmonológiai Intézet Légzésrehabilitációs Osztályán fekvő betegek körében 2019. július 1. és december 31. között. A véletlenszerűen kiválasztott 300, 40 év feletti betegnek ismertük az antropometriai, légzésfunkciós vizsgálati eredményét és laboratóriumi paramétereit. Adatokat gyűjtöttünk a dohányzási szokásokról, az előző évi exacerbatiók számáról és a kortikoszteroidok használatáról is. Az életminőség mérésére a betegségspecifikus Szent György-féle Légzési Kérdőív magyar nyelvre validált változatát használtuk. A metabolikus szindrómát a Nemzetközi Diabetes Szövetség kritériumai alapján határoztuk meg. Eredmények: A metabolikus szindróma a betegek 72%-ánál fordult elő, férfi: 65,9% nő: 77,2% (p = 0,031). A metabolikus szindrómás betegek esetében rövidebb 6 perces sétatávolságot mértünk ([m] 250 [150-330] vs. 295 [162-360]; p = 0,384), és szignifikánsan több volt az előző évi exacerbatiók száma (3 [0-6] vs. 1 [1-2]; p<0,001) a nem metabolikus szindrómás betegekhez képest. A BMI-re történő stratifikáció után a metabolikus szindróma jelenléte nagyobb volt BMI≥25 kg/m2 esetén. A hasi elhízás, a magas vérnyomás, a hyperlipidaemia és a hyperglykaemia szignifikánsan gyakoribb volt BMI≥25 kg/m2 esetén (p<0,001). Következtetés: Eredményeink azt sugallják, hogy a metabolikus szindrómás betegekben megnő az együttes morbiditási index, különösen azok körében, akik túlsúlyosak vagy elhízottak. Ezért a COPD-s betegekben nagyon fontos időben felismerni és megfelelően kezelni a metabolikus szindrómát. Orv Hetil. 2021; 162(5): 185-191.

SUMMARY

INTRODUCTION

Both obesity and the lack of physical activity among chronic obstructive pulmonary disease (COPD) patients increase the risk of developing metabolic syndrome.

OBJECTIVE

The goal of our study was to assess the prevalence of metabolic syndrome among COPD patients and to examine its correlation with age, gender, comorbidities, lung function values, nutritional status, exercise capacity, and quality of life.

METHOD

A cross-sectional study was performed at the Department of Pulmonary Rehabilitation of the Hungarian National Korányi Institute for Pulmonology between July 1st and December 31st, 2019. A total of 300 patients aged over 40 were selected at random. Anthropometric data were collected along with lung function values, laboratory parameters, smoking status, the number of exacerbations in the previous year, and the use of corticosteroids. Quality of life was measured by the validated Hungarian, COPD-specific Saint George Respiratory Questionnaire. Metabolic syndrome was defined according to the International Diabetes Federation criteria.

RESULTS

Metabolic syndrome affected 72% of COPD patients (male: 65.9%, female 77.2%; p = 0.031). In patients with metabolic syndrome, shorter 6-minute walking distance was measured ([m] 250 [150-330] vs. 295 [162-360]; p = 0.384) and the number of exacerbations in the previous year was significantly higher (3 [0-6] vs. 1 [1-2]; p<0.001) compared to patients with no metabolic syndrome. After stratification for BMI, metabolic syndrome was more frequent in the case of BMI≥25 kg/m2. Central adiposity, hypertension, hyperlipidemia, and hyperglycemia were also significantly more frequent among patients with BMI≥25 kg/m2 (p<0.001).

CONCLUSION

Our results suggest that the co-morbidity index increases in patients with metabolic syndrome, especially in overweight or obese patients. Therefore, early detection and appropriate treatment of metabolic syndrome in patients with COPD is very important. Orv Hetil. 2021; 162(5): 185-191.

[Musculoskeletal relevance of obesity: a new approach to an old topic]

Authors discuss the musculoskeletal aspects of obesity by applying a novel approach. Biochemical changes associated with obesity and especially metabolic syndrome, may have a great impact on the function of bones, joints and muscles. Therefore we need a new view and new strategies in rheumatic diseases. Obesity-associated metabolic changes should be considered during the progress of as well as the selection of treatment in inflammatory rheumatic diseases. Individualised treatment is necessary due to associated comorbidities as well. Orv Hetil. 2019; 160(44): 1727-1734.

[Review of the relation between gut microbiome, metabolic disease and hypertension]

Gut flora has personal characteristics for each individual, similar to the fingerprints, consisting of a special mixture of bacterial species living in the intestines, now referred to as the gut microbiome. There is a strong correlation between the loss of microbial diversity and the functional bowel disorders, obesity, type 2 diabetes and cardiovascular disease as well as many autoimmune disorders. With genetic testing of stool diversity of the gut microbiome and exact analysis of the species and phylogenetic classification of the gut flora, the changes of diversity can be identified and the overgrowth of some bacteria can be revealed. In cases with pre- and manifest hypertension, an overgrowth of species from the phylum Firmicutes has been reported along with the relative decline of the phylum Bacteroidetes as opposed with cases of normotension. At the same time, the physiological balance among bacterial families was lost. According to the first studies, there is a correlation between hypertension and the lost balance of the gut microflora, both in animal experiments and in the human clinical setting. This evidence also suggests that targeted dietary alteration of the gut microbiome can be a new innovative approach in the treatment of hypertension. Orv Hetil. 2018; 159(9): 346-351.

[Non-alcoholic fatty liver disease, as a component of the metabolic syndrome, and its causal correlations with other extrahepatic diseases]

Non-alcoholic fatty liver disease is the most common non-infectious chronic liver-disease in our age, and is a spectrum of all the diseases associated with increased fat accumulation in the hepatocytes. Its development is promoted by sedentary life-style, over-feeding, and certain genetic predisposition. Prevalence in the adult population, even in Hungary is ~30%. In a part of cases, this disease may pass into non-alcoholic steatohepatitis, later into fibrosis, rarely into primary hepatocellular cancer. Fatty liver is closely and bidirectionally related to the metabolic syndrome and type 2 diabetes, and nowadays there is a general consensus that fatty liver is the hepatic manifestation of the metabolic sycndrome. The importance of the fatty liver has been highly emphasized recently. In addition to the progression into steatohepatitis, its causal relationship with numerous extrahepatic disorders has been discovered. In our overview, we deal with the epidemiology, pathomechanism of the disease, discuss the possibilities of diagnosis, its relationship with the intestinal microbiota, its recently recognized correlations with bile acids and their receptors, and its supposed correlations with the circadian CLOCK system. Hereinafter, we overview those extrahepatic disorders, which have been shown to be causal link with the non-alcoholic fatty liver disease. Among these, we emphasize the metabolic syndrome/type 2 diabetes, cardiovascular disorders, chronic kidney disease, sleep apnea/hypoventilation syndrome, inflammatory bowel disease, Alzheimer's disease, osteoporosis, and psoriasis, as well. Based on the above, it can be stated, that high risk individuals with non-alcoholic fatty liver disease need systemic care, and require the detection of other components of this systemic pathological condition. While currently specific therapy for the disease is not yet known, life-style changes, adequate use of available medicines can prevent disease progression. Promising research is under way, including drugs, manipulation of the intestinal flora or the possibility of therapeutic use of bile acid receptors, and also bariatric surgery. Orv Hetil. 2017; 158(52): 2051-2061.

[Metabolic complications of obesity during adolescence, particularly regarding elevated uric acid levels]

INTRODUCTION

Obesity is a social problem worldwide that leads to several diseases, including metabolic syndrome, hypertension and cardiovascular diseases. It is known that hyperuricemia in adults may be associated with these disorders.

AIM

The aim of the authors was to investigate the frequency of metabolic syndrome and hyperuricemia and their relationship among obese adolescents.

METHOD

This was a cross-sectional study. The authors analysed the data of 162 overweight or obese adolescents (100 boys and 62 girls) who were previously investigated in a paediatric endocrinology consultation. Anthropometric and metabolic parameters were evaluated in all subjects. Healthy, age-matched, non obese girls (n = 20) and boys (n = 26) were used as controls. The age of overweight or obese boys was: 12 ± 2.1 and overweight or obese girls was 11 ± 2.5 years. In the control group the age of boys was 12.9 ± 2.5 years and the age of girls was 13.2 ± 1.6 years. Linear regression was used to evaluate associations between uric acid and clinical and laboratory findings associated with metabolic syndrome.

RESULTS

Obese or overweight subjects had greater BMI SDS (boys, 3.4 ± 1.3 vs 0.05 ± 0.4 in controls, p<0.0001; girls, 3.75 ± 1.4 vs 0.72 ± 0.9 in controls, p = 0.0001), waist circumference (boys, 90.1 ± 9.2 vs 82.3 ± 6.4 cm in controls; girls, 90.2 ± 8.6 vs 78.1 ± 7.2 cm in controls, p<0.001), higher systolic blood pressure (boys, 125 ± 14.3 vs 118.2 ± 10.8 mmHg in controls, p = 0.02; girls, 125.8 ± 11.8 vs 119.8 ± 8.8 mmHg in controls, p<0.01), diastolic blood pressure (boys, 78.4 ± 9.1 vs 71.2 ± 8.0 mmHg in controls, p = 0.0003; girls, 76.45 ± 7.2 vs 73.2 ± 6.3 mmHg in controls, p = 0.0453). The prevalence of metabolic syndrome was 45/162 (27.8%) and the prevalence of hyperuricemia was 62/162 (38.3%). Of the 45 subjects with metabolic syndrome, 30 (66.7%) had hyperuricemia.

CONCLUSIONS

It can be concluded that hyperuricemia is strongly associated with metabolic syndrome. The high concentration of uric acid predicts cardiovascular risk in adulthood. It is important for paediatricians to determine and assess uric acid levels in overweight or obese adolescents.

[The role of β-blockers in patients with metabolic syndrome and hypertension]

The choice of treatment of patients with hypertension should not be based solely on the blood pressure value, because the risk of cardiovascular diseases are influenced by the presence and magnitude of other risk factors, too. The presence of a metabolic disease (diabetes mellitus, metabolic syndrome) itself categorizes the patient as a high risk individual. In such cases the use of combined treatment is usually considered. For example, in case of hypertension aggravated by left ventricular dysfunction, ischaemic heart disease or cardiac insufficiency, β-blocker treatment is usually included in the combination of the first setting.