Prevalence of metabolic syndrome and related metabolic traits in an island population of the Adriatic

BACKGROUND

Metabolic syndrome, a constellation of risk factors associated with cardiovascular disease and Type 2 diabetes, has reached epidemic proportions worldwide. Epidemiological studies in transitional societies will provide insight into the underlying factors that interact in its manifestation.

AIMS

To estimate the prevalence of metabolic syndrome, provide a comparative analysis of two metabolic syndrome definitions and assess clustering and association of metabolic traits and cardiovascular diseases in an Adriatic island population.

SUBJECTS AND METHODS

In a cross-sectional study, data on four anthropometric, blood pressure and 11 biochemical traits were obtained from 1430 adults from the island of Hvar.

RESULTS

Prevalence of metabolic syndrome was 25% and 38.5% based on Adult Treatment Panel III and International Diabetes Federation definitions, respectively. Rates of abdominal obesity, elevated blood glucose and hypertension were high. Among the traits not included in the definitions, levels of LDL, total cholesterol and fibrinogen were markedly elevated. The majority of the phenotypes were significantly associated with the syndrome, the strongest being waist circumference.

CONCLUSION

The Croatian islanders are characterized by a high prevalence of metabolic abnormalities. Central obesity is the strongest contributor of the syndrome. With a high prevalence of dyslipidemia and pro-inflammatory factors, the population is at substantial risk for cardiovascular diseases.

[Leprosy in Guadeloupe (French West Indies): declining disease, increasing diagnosis delay]

INTRODUCTION

Endemic for nearly three centuries, leprosy is declining in Guadeloupe: its prevalence has decreased by 75 p. 100 over the last decade. Because it has become rare, it may well be overlooked.

PATIENTS AND METHODS

Retrospective study of all the new cases of leprosy diagnosed in Guadeloupe from May 1996 to May 2001.

RESULTS

In 10 cases of the 41 reported in this study, diagnosis had been delayed by more than 6 months. Nine of these 10 cases presented with classical clinical signs. The mean delay before diagnosis in these 10 cases was of 22 months (range: 7-36 months); the mean number of consultations with a physician before the final diagnosis was of 3.2 (range: 2-8). The mean age at the time of diagnosis in patients in whom diagnosis was delayed was significantly greater than those in whom diagnosis was confirmed rapidly (55 vs. 37 years).

DISCUSSION

In Guadeloupe, one patient out of 4 presenting with leprosy is diagnosed with a delay of more than 6 months, despite a classical clinical presentation. This is deleterious to the patients and health economics. The patients in whom diagnosis was delayed were older. This epidemiological tendency appears inherent to this form of "residual leprosy". The present rareness of the disease is responsible for a lack of knowledge of the disease by the physicians through lack of experience. This phenomenon is also observed for syphilis and measles. There is a real risk of underestimation or erroneous diagnosis.

Do training-dependent differences in perspiration exist between healthy and atopic subjects?

Sweating (perspiratio sensibilis) serves predominantly for thermoregulation and is triggered, among other stimuli, by physical stress. Although consensus on sex-dependent differences in sweating has not been reached so far and recent studies revealing abnormal diminution of the sweating capacity in atopic subjects are mainly based on heat exposure experiments, the influence of endurance training on perspiration in atopics has not yet been evaluated. Using a special sweat collector device reliable even during intensive body movement, we compared the sweat production of age-matched male and female healthy controls (14 m, 10 f) to that of in-patients with atopic eczema (AE: 14 m, 10 f) during and 5 min after physical exercise (30 min) with a bicycle ergometer under standardized experimental conditions. The individual stress limit was determined by a previous endurance test including repeated lactate blood level measurements and continuous heart rate control. Informed consent was obtained from every participant in the study. One half of both the patients and the controls underwent three week endurance training, and the preceding sweat measurements were repeated in all patients and controls after the training period under identical conditions. On average, the healthy males perspired nearly twice as much as the corresponding females (p < 0.0016). Highly significant mean differences of maximum sweat secretion rates were also found between the atopics and the controls. Healthy individuals of both sexes perspired nearly three times as much as did the patients with AE (males: p < 0.0004; females: p < 0.00009). Among the atopics there were remarkable, yet statistically insignificant, sexual differences in sweat production. After three weeks, sweating rates were similar to the initial ones in the training group as well as in the non-trained control group. Gender differences in perspiration do not only exist between healthy males and females but also in patients with atopic skin disorder, yet the latter ones at significantly lower levels as compared to healthy control subjects. No influence of a three-week-exercise phase on sweat secretion in atopics and controls could be proven. For designing further studies on intra- or intersexual differences of drug-independent perspiration, standardized physical stress can be recommended as an experimental prerequisite for sweat measurements.

[Sex-dependent differences in sweating of normal probands and atopic patients in cardiovascular stress]

Sweating (perspiratio sensibillis) due to cholinergic sweat gland activity serves predominantly for thermoregulation and is triggered among others by physical stress. Individuals suffering from atopic eczema usually respond to sweating with generalized itching. Different sweat regulation in atopic patients and healthy controls under cholinergic stimulation and heat chamber provocation tests has already been examined in several studies. However, no clinical trial has yet been done on atopic sweat regulation during physical stress. Sex-specific sweat secretion rates have not been evaluated. In our trial we compared sweat amounts of male and female atopics (14 m, 10 f) and healthy controls (14 m, 10 f) during and after physical activity on a bicycle ergometer. We used a special sweat collector system reliable even at intensive body movement. The individual stress limit had been determined by previous endurance training with lactate level and heart rate measurement. We found a highly significant difference in maximum sweat amounts between atopics and controls. On average, healthy individuals (of both sexes) perspired nearly three times as much as atopic patients. Male controls perspired nearly twice as much as corresponding females. Among the atopics, sex-specific differences were found to be not statistically relevant.

Physical stress-induced secretion of adrenal and pituitary hormones in patients with atopic eczema compared with normal controls

Atopic eczema is a chronic inflammatory skin disease which shares some psychological and neuroendocrine disturbances with patients suffering from depression. In view of recent findings of an attenuated response of the hypothalamic-pituitary-adrenal (HPA) system in patients with atopic eczema during a human corticotropin-releasing hormone (hCRH) challenge paradigm fourteen consecutive non-specifically trained in-patients with atopic eczema (8 men, 6 women) and an age-matched control group (8 men, 6 women) performed exhausting incremental graded bicycle exercise to evaluate cortisol, adrenocorticotropin (ACTH), beta-endorphin, epinephrine and norepinephrine releases induced by physical stress. The exercise yielded significant increases in cortisol, ACTH, beta-endorphin, epinephrine and norepinephrine concentrations in both groups. Patients with severe eczema displayed a significantly lower increase in norepinephrine levels when compared with the less affected patient group. In contrast to the challenge with exogenous hCRH no substantial difference in the net responses of ACTH and cortisol could be detected between patients with atopic eczema and controls using the physical stress paradigm. These substantial differences in the net outcome between both challenges may be related to the potential synergizing effects of various neuropeptides, e.g. CRH and vasopressin, when activating the HPA system by challenges at a suprapituitary site which may override subtle disturbances in the responsivity of the HPA system as revealed by CRH challenge alone in patients with atopic eczema.

Association between deletion polymorphism of the angiotensin-converting enzyme gene and cerebral atherosclerosis

We investigated deletion polymorphism in the gene for angiotensin-converting enzyme in patients with angiographically verified cerebral atherosclerosis. Genotypes were determined by the polymerase chain reaction with oligonucleotide flanking of the polymorphic region of intron 16 of the angiotensin-converting enzyme gene. Results of angiotensin-converting enzyme genotyping showed 46% of 50 studied patients to be homozygous for the DD allele, whose prevalence was significantly increased as compared with a group of controls without atherosclerotic changes. In this control group, the following genotypes were observed (%): II = 24, ID = 52 and DD = 24. The frequency of the I and D alleles in the group of patients with cerebral atherosclerosis was 0.28 and 0.72, respectively, whereas in the group without atherosclerosis it was 0.50 for both. Furthermore, in the present study, the DD genotype was associated with a high level of serum angiotensin-converting enzyme activity, total and LDL-cholesterol and triacylglycerol. A newly established association between DD genotype and cerebral atherosclerosis, detected even in our small group, supports the view that angiotensin-converting enzyme polymorphism might be indicative of the development of cerebral atherosclerosis.

Analysis of the in vitro secretory activity of human pituitary adenomas: modification of corticotropin release from adenoma tissue explant cultures by addition of a human plasma ultrafiltrate bioactive fraction

The lack of control of tumour behaviour is manifested in different ways, depending primarily on the type of tumour. This results in numerous problems of tumour diagnosis and therapy. In the case of "benign" tumours, like pituitary adenomas, in vitro studies are often used for evaluation of the tumour. The use of tissue explant cultures of human pituitary adenomas and the comparison of the feature of cultured tumours with their behaviour in vivo showed that corticotropin is released not only from the tumours associated with Cushing's disease, but also from clinically non-functioning tumours. Hence, it was supposed that the release of corticotropin in vivo from non-secreting tumours is probably under the influence of certain neuroendocrine and/or systemic humoral factors. To test this possibility, samples of 22 tumours were cultured in plain culture medium or in the presence of the "human plasma ultrafiltrate bioactive fraction" (tentatively termed as TBP) prepared by anion-exchange chromatography. In the presence of TBP the release of corticotropin was strongly inhibited in adenomas showing relatively high spontaneous secreting activity in vitro (> 200 ng/l in 24 hours), while immunohistochemistry of these tumours indicated accumulation of corticotropin inside the cells. In contrast, TBP stimulated corticotropin release from tumours that showed relatively low basic corticotropin release (< 200 ng/l in 24 hours), with no obvious change in cellular corticotropin immunoreactivity. Such a dual activity of TBP was not observed for 8 samples of adenomas cultured in the presence of surrounding pituitary tissue, probably because TBP did not affect corticotropin secretion by the normal pituitary cells (as indicated by immunohistochemistry). From these results, it appears that TBP could be one of the humoral factors involved in the regulation of corticotropin release from pituitary adenoma tissue. Its possible involvement in the regulation of corticotropin release from normal pituitary tissue, however, is uncertain.

[Group sports as adjuvant therapy for patients with atopic eczema]

The therapeutic value of regular physical exercise for patients with atopic eczema (AE) and other chronic inflammatory dermatoses has not yet been investigated systematically. At our institution an adjuvant group sports programme for voluntary inpatients has been in place for 3 years. Using a standardized questionnaire we found positive psychological influences of this program on the patients' mood and psychosocial wellbeing. Since most dermatologists, however, regard sweating as detrimental for patients with AE, we studied the impact of regular sports activities on the skin condition of AE-patients otherwise subdued to usual dermatotherapy (yet without corticosteroids) by aid of a standardized symptomscore system. Thirty inpatients with AE participated regularly in the sports programme, another 30 inpatients with AE (the control group) did not. The skin condition improved similarly the two groups over the study period of about 3 weeks. Cutaneous thermoregulation (with one arm in a 41 degrees C water bath as thermic stimulus) was examined in patients with AE before and after the study period. While many AE patients initially showed paradoxical, i.e. decreasing, skin temperature in the contralateral arm, after 3 weeks of physical training most of the participants had normalized consensual, i.e. increased, temperature reaction to the same warmth exposure. The conclusion is drawn that regular sports may be of adjuvant therapeutic value in patients suffering from AE, except in the acute stages of the disease.

Apolipoprotein E phenotypes and genotypes as determined by polymerase chain reaction using allele-specific oligonucleotide probes and the amplification refractory mutation system in children with insulin-dependent diabetes mellitus

The frequency of apolipoprotein E (apo E) phenotypes and genotypes due to allelic variation at amino acids 112 and 158 was analysed in 50 children with type I diabetes. Phenotypes were determined by isoelectric focusing and genotypes by the technique of polymerase chain reaction using allele-specific oligonucleotide probes (PCR/ASO) and the amplification refractory mutation system (ARMS). Discrepancies between phenotypes and genotypes as assigned by PCR/ASO were observed in 12 (24%) cases and by ARMS in eight (16%) cases. Results revealed the apo E3/3 genotype, as assigned by ARMS, to be the most frequent one (70%), followed by apo E3/4 in 16%, apo E2/2 in 2%, apo E2/3 in 8%, apo E2/4 in 2% and apo E4/4 in 2% of the cases. Apo E3/4 genotype and phenotype were more frequently present in the children with type I diabetes as compared with the diabetic adults previously reported on.

Polymorphism of apolipoprotein E, lipoprotein(a), and other lipoproteins in children with type I diabetes

We assessed the effect of particular apolipoprotein (apo) E phenotypes, lipoprotein(a) [Lp(a)], and other lipoproteins on the development of dyslipoproteinemia in 450 patients with type I diabetes, ages 13-14 years. The control group consisted of 450 healthy school children of both sexes, ages 13-14 years. Both groups were found to be normolipidemic, but the concentration of Lp(a) was significantly (P &lt; 0.05) higher in the diabetic children than in the control group. Apo E 3/2 and apo E 4/4 phenotypes were more frequent in the group of diabetics. Diabetics with the apo E 3/3 phenotype had higher concentrations of very-low-density lipoprotein (VLDL) and Lp(a), and lower concentrations of low-density lipoprotein (LDL) than the apo E 3/3 nondiabetics. For apo E 3/2 phenotypes, total cholesterol, LDL cholesterol, LDL, apo A-I, and Lp(a) concentrations were higher in the diabetic children than in the control group; for apo E 4/3 phenotypes, this was true for triglycerides and VLDL cholesterol. The distribution of Lp(a) lipoprotein concentrations between 0.01 and &gt; 0.5 g/L indicated a more frequent occurrence of higher Lp(a) values in diabetic children than in the control group. Results of this study indicate that an increased concentration of Lp(a) lipoprotein and apo E 3/2 and apo E 4/3 phenotypes contribute to the expression of dyslipoproteinemia in type I diabetes in childhood.

Polymorphism of apolipoprotein E, lipoprotein(a), and other lipoproteins in children with type I diabetes

We assessed the effect of particular apolipoprotein (apo) E phenotypes, lipoprotein(a) [Lp(a)], and other lipoproteins on the development of dyslipoproteinemia in 450 patients with type I diabetes, ages 13-14 years. The control group consisted of 450 healthy school children of both sexes, ages 13-14 years. Both groups were found to be normolipidemic, but the concentration of Lp(a) was significantly (P < 0.05) higher in the diabetic children than in the control group. Apo E 3/2 and apo E 4/4 phenotypes were more frequent in the group of diabetics. Diabetics with the apo E 3/3 phenotype had higher concentrations of very-low-density lipoprotein (VLDL) and Lp(a), and lower concentrations of low-density lipoprotein (LDL) than the apo E 3/3 nondiabetics. For apo E 3/2 phenotypes, total cholesterol, LDL cholesterol, LDL, apo A-I, and Lp(a) concentrations were higher in the diabetic children than in the control group; for apo E 4/3 phenotypes, this was true for triglycerides and VLDL cholesterol. The distribution of Lp(a) lipoprotein concentrations between 0.01 and > 0.5 g/L indicated a more frequent occurrence of higher Lp(a) values in diabetic children than in the control group. Results of this study indicate that an increased concentration of Lp(a) lipoprotein and apo E 3/2 and apo E 4/3 phenotypes contribute to the expression of dyslipoproteinemia in type I diabetes in childhood.

Lipid and lipoprotein contents of human follicular fluid

The concentrations of total cholesterol, phospholipids, triacylglycerols and lipoproteins were measured in 87 follicular fluids obtained from 35 women undergoing in vitro fertilization and embryo transfer. The results were correlated with the levels of progesterone in follicular fluid. Two different types of ovarian stimulation were used. High density lipoproteins were the dominant lipoproteins found in the preovulatory follicular fluid. Low density lipoproteins were absent or appeared in trace amounts. Significantly higher triacylglycerol and high density lipoprotein levels were found when stimulation with human menopausal gonadotropins and chorionic gonadotropin was applied, as compared to the clomiphene citrate-menopausal gonadotropin-chorionic gonadotropin menstrual cycle. In both groups, extracorporal fertilization resulted in cleavage of oocytes and embryo transfer. No significant correlation between any follicular fluid lipid and progesterone concentration was found. The lipids estimated in the follicular fluid appeared to have no influence on the oocyte fertilizability. The presence of triacylglycerols and high density lipoproteins in the follicular fluid may indicate follicular wall permeability under the treatment with menopausal gonadotropins.

[Digitalis therapy in medical practice. Research on indications and dosage criteria in general practice]

Two hundred digitalized patients under nine freely practising physicians were investigated. One hundred and ninety-six patients received digoxin or one of its derivatives. Of these, 50% did not have therapeutic serum glycoside concentrations, 48% were in the mostly subtherapeutic range and 2% were in the potentially toxic range. Signs of glycoside intoxication were not found. A substantiated indication for glycoside therapy was found in the final analysis in 55% of the patients. In 128 patients, the methyldigoxin dose calculated (0.16 +/- 0.030 mg/d) was markedly in excess of that actually prescribed (0.13 +/- 0.050 mg/d; p less than 0.001), so that there were indications of a general underdigitalization. In addition, it was not possible to anchor the restrictive kidney function as a reason for reduction of digoxin dosage in the prescription behavior. In the long run, only 36% of the patients with justified indication and therapeutic serum glycoside concentration as well as (with reservations) the 3% with potentially toxic serum glycoside concentration profited from the glycoside therapy.

Immunoregulatory properties and LP-pattern of human ovarian carcinoma ascites and pleural effusions of nonmalignant origin

The immunoregulatory activity of ascitic fluids obtained from patients with ovarian carcinoma, and pleural effusions collected from patients with various nonmalignant diseases, was tested. The following assays were performed: in vivo, PFC-response of mouse splenocytes to SRBC; in vitro, antibody-dependent cellular cytotoxicity (ADCC), and phagocytic activity of human peripheral blood mononuclear cells (PBMoC). The migration ability of mouse splenocytes in the presence of ascitic fluids was also evaluated. Parallelly, lipid (triglyceride and cholesterol) and lipoprotein (high-density/HDL/, low-density/LDL/, and very-low-density/VLDL/) content in ascites and pleural effusions, were determined. Both types of fluids suppressed the PFC-response and inhibited phagocytosis of 51Cr-labeled sheep erythrocytes by PBMoC, but augmented ADCC of PBMoC against sheep erythrocytes. An elevation of VLDL and a decrease of HDL and LDL in ascitic fluids and pleural effusions, as compared to normal human sera, were found. There were similar changes in the cholesterol content of these lipoprotein fractions, i.e., an increase of VLDL- and a decrease of HDL- and LDL-cholesterol.