Metabolic consequences of recombinant human growth hormone therapy in patients with Turner syndrome

INTRODUCTION

Turner syndrome (TS) predisposes to metabolic complications. Currently, TS patients are treated with recombinant human growth hormone (rGH) as standard therapy. The long-term effect of this therapy on carbohydrate metabolism remains unclear. Aim of the study: To assess possible metabolic alterations following rGH therapy.

MATERIAL AND METHODS

Material and methods: We enrolled 53 TS participants, comprising 37 patients who finished rGH therapy (group 1) and 16 patients who did not receive growth promoting therapy (group 2). Several anthropometric measurements were made. Carbohydrate and lipid metabolism, adipokines, and hs-CRP were assessed basing on laboratory test. The following indices were calculated: HOMA-IR, HOMA-b, QUICKI, and Matsuda.

RESULTS

There were no statistically significant differences between the 2 groups in terms of BMI or WHR. There was a statistically significant lower mean percentage of fat tissue in group 1 compared to group 2 (27.46% vs. 31.75%). Insulin resistance and sensitivity indices were not statistically different between groups. Using the Matsuda index, more patients who met criteria of insulin resistance were found in group 2 than in group 1 (56.25% vs. 37.84%); however, this difference was not statistically significant (p = 0.2). No statistically significant differences were found in lipid profile, adipokines, and hsCRP between groups.

CONCLUSIONS

rGH therapy leads to a beneficial change in body composition of TS patients despite unchanged BMI. A decrease in body fat persists for several years after finishing rGH treatment; rGH treatment is connected with a trend toward increased insulin sensitivity.

The incidence of insulin resistance based on indices calculated using the HOMA and Belfiore methods and its impact on the occurrence of metabolic complications in prepubertal children born small for gestational age

INTRODUCTION

Children born small for gestational age (SGA) are predisposed to obesity, insulin resistance (IR), and lipid disorders. The HOMA-IR index is commonly used to assess IR (IRIHOMA), calculated from fasting glucose and insulin. However, sometimes, during the oral glucose tolerance test (OGTT), elevated and prolonged postprandial insulin secretion is observed despite normal fasting insulin levels. IRIBelfiore is an IR index that analyses glucose and insulin levels during OGTT according to the method proposed by Belfiore.

THE AIM OF THE STUDY

was to assess the frequency of IR based on IRIHOMA and IRIBelfiore results in SGA children aged 6-8 years, after catch-up phenomenon, to determine the usefulness of IRIBelfiore in diagnosis of IR and in predicting future metabolic complications.

MATERIAL AND METHODS

In 129 SGA normal-height children, aged 6-8 years, height, weight, waist circumference, blood pressure, as well as lipids, IGF-1, cortisol, C-peptide, leptin, adiponectin, and resistin concentrations were measured. The glucose and insulin concentrations were evaluated at 0, 60, and 120 minutes of OGTT.

RESULTS

IRIHOMA was normal in all children, while elevated IRIBelfiore was found in 22.5% of them. Children with IR diagnosed by IRIBelfiore were taller, had higher blood pressure, higher leptin, and lower HDL-cholesterol concentrations.

CONCLUSIONS

It seems worth recommending IRIBelfiore derived from OGTT as a valuable diagnostic tool for identifying IR in SGA prepubertal children. Abnormal IRIBelfiore is related to higher blood pressure and lower HDL-cholesterol concentration in this group.

The risk of subclinical carotid atherosclerosis in patients with chronic hepatitis C

INTRODUCTION

The role of hepatitis C virus in the pathogenesis of atherosclerotic disease has been suggested by several studies.

AIM

To assess the association between subclinical carotid atherosclerosis and chronic hepatitis C.

METHODS

40 patients infected with chronic hepatitis C and 40 control cases were evaluated by anthropometric and metabolic measurements. The risk of subclinical atherosclerosis was assessed by ultrasound measurement of carotid intima-media thickness. A high cardiovascular risk atherosclerosis was defined by carotid intima-media thickness > 75th percentile.

RESULTS

The carotid intima-media thickness and the prevalence of high cardiovascular risk atherosclerosis were significantly higher in the group infected with hepatitis C compared to the control group (0.68 VS 0.60, p=0.02) and (82.5% vs. 40%; 0.001) respectively. In multivariate studies, activity ≥ A2 and age> 40 years were the independent factors associated with the carotid intima-media thickness and hepatitis C was the only independent factor associated with high cardiovascular risk atherosclerosis (OR=4.81 CI at 95%: 1.6-14.42).

CONCLUSIONS

In our study, chronic hepatitis C was associated with a high risk of carotid atherosclerosis.

Insulin Resistance is Associated with Central Pain in Patients with Fibromyalgia

BACKGROUND

Insulin resistance (IR) is a pathological condition in which cells fail to respond normally to insulin. IR has been associated with multiple conditions, including chronic pain. Fibromyalgia (FM) is one of the common generalized chronic painful conditions with an incidence rate affecting 3% to 6% of the population. Substantial interest and investigation into FM continue to generate  many hypotheses.The relationship between IR and FM has not been explored. IR is known to cause abnormalities in the cerebral microvasculature, leading to focal hypoperfusion. IR also has been shown to cause cognitive impairment in FM patients, as in parkinsonism. As demonstrated by advanced imaging methods, similar brain perfusion abnormalities occur in the brain of patients with FM as with IR.

OBJECTIVES

To determine the potential association between FM and IR.

SETTING

Subspecialty pain medicine clinics.

STUDY DESIGN

Observational cross-sectional study.

METHODS

Laboratory data was extracted through a retrospective review of medical records from patients who had met the American College of Rheumatology (ACR) criteria for FM. The Hemoglobin A1c (HbA1c) values from 33 patients with FM were compared with the means of the glycated HbA1c levels of 2 control populations. In addition, established indices of IR [Quantitative Insulin Sensitivity Check Index (QUICKI) and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)] were calculated in a subgroup of patients in whom the analytes necessary for these calculations were available. To assess for confounding factors, the associations between HbA1c, QUICKI, HOMA-IR, fasting insulin levels, and glucose, after controlling for age, were explored by multiple analyses of variance with relation to gender and ethnicity.

RESULTS

We found an association between IR and FM that was independent of age, gender, and ethnicity. We found that patients with FM belong to a distinct population that can be segregated from the control groups by their HbA1c levels, a surrogate marker of IR. This was demonstrated by analyzing the data after introducing an age correction into a linear regression model. This strategy showed significant differences between patients with FM and control subjects (P < 0.0001 and P  = 0.0002, for 2 separate control populations, respectively). A subgroup analysis using the QUICKI and HOMA-IR showed that all patients with FM in this subgroup (100%) exhibited laboratory abnormalities pointing to IR.

LIMITATIONS

Small observational cross-sectional study. There are also intrinsic limitations that are attributed to cross-sectional studies.

CONCLUSION

The association demonstrated in this study warrant further investigation, including the pursuit of randomized, double-blind clinical trials to determine the effect of improving insulin sensitivity in FM related pain scores. Such studies could unveil a potential pathogenetic relationship between FM, central pain, and IR. Based on these initial findings, we present the hypothesis that IR may underlie pathological mechanisms leading to central pain. If confirmed, this may lead to a paradigm shift in the management of central pain.

Usefulness of the metabolic syndrome diagnosis in obese children in clinical practice

INTRODUCTION

In the light of recent studies, the usefulness of the metabolic syndrome diagnosis in obese pediatric patients seems to be controversial. It leads to the pressing questions, if the metabolic syndrome diagnosis is reflecting risk of the cardiovascular complications in obese chil-dren.

AIM OF THE STUDY

To evaluate the incidence of metabolic syndrome in obese children, asses the role of insulin resistance in the metabolic complications and investigate if the diagnosis of MS has a clinical value in that group of patients.

MATERIAL AND METHODS

After the retrospective analysis of 588 records of obese children treated in metabolic outpatient clinic, 289 children (145 boys) in the mean age of 11 years, was qualified to the study. Diagnosis of metabolic syndrome was based on IDF 2009 criteria and HOMA-IR was used in the assessment of insulin resistance.

RESULTS

Metabolic syndrome was diagnosed in 69 children (24%) including 42 girls (61%, p < 0.05). Mean age was higher (12.4 vs. 10.9, p < 0.05) in patients with metabolic syndrome. Initial BMI Z-score was similar in the both groups (2.93 SD vs. 2.92 SD). However, further follow-up showed significantly (p < 0.001) less effective BMI z-score reduction in patients with metabolic syndrome. Insulin resistance was observed significantly more often in children with metabolic syndrome (77% vs. 35%, p < 0.0001). Moreover, ami-notransferases were significantly higher in boys with metabolic syndrome (AST = 35 vs. 28 U/l, ALT = 38 vs. 23 U/l, p < 0.0001).

CONCLUSIONS

The diagnosis of metabolic syndrome in obese children seems to have a predictive value for the clinical practice. Affected children are older and their criteria are present more often in girls. Insulin resistance seems to be an important factor associated with metabolic syn-drome in obese children. The outcomes of behavioral therapy are less effective in children with metabolic syndrome. Affected boys are at higher risk of non-alcoholic fatty liver disease (NAFLD) in the future.

[Correlation of insulin resistance with male reproductive hormone levels and semen parameters]

OBJECTIVE

To investigate the influence of insulin resistance on male reproductive hormones and semen quality.

METHODS

Using the electrochemiluminescence method, we measured the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2) and testosterone (T) in the serum of 83 infertile males. We detected the levels of fasting plasma glucose (FPG) and fasting insulin (FINS) and calculated the insulin resistance index presented as homeostasis model assessment of insulin resistance (HOMA-IR). Based on HOMA-IR, we divided the patients into three tertile groups, T1 (HOMA-IR 0.36－0.55, n = 27), T2 (HOMA-IR 0.56－0.80, n = 28) and T3 (HOMA-IR 0.81－1.97, n = 28), obtained their semen parameters by computer-assisted semen analysis (CASA) and analyzed the correlation of HOMA-IR with male reproductive hormone levels and semen parameters.

RESULTS

With the elevation of HOMA-IR, the patients of the T1, T2 and T3 groups showed significant decreases in the serum T level (［14,26 ± 4.27］ vs ［14.75 ± 5.00］ vs ［11.62 ± 3.68］ nmol/L, P <0.05) and the percentage of progressively motile sperm (PMS) (［51.04 ± 15.10］% vs ［48.04 ± 16.24］% vs ［37.84 ± 18.23］%, P <0.05). HOMA-IR was correlated negatively with the serum T level (r = －0.333, P = 0.002), semen volume (r = －0.23, P = 0.029) and PMS (r = －0.27, P = 0.015), and so was FINS with the serum T level (r = －0.327, P = 0.003) and PMS (r = －0.315, P = 0.004), while the semen volume was correlated positively with the levels of serum T (r = 0.221, P = 0.048) and FSH (r = 0.222, P = 0.047). Multivariate linear regression analysis showed that HOMA-IR was an independent influencing factor for PMS and the body mass index (BMI) was that for the semen volume and total sperm count.

CONCLUSIONS

Insulin resistance may reduce semen quality by changing the levels of male reproductive hormones.

Pathogenesis of insulin resistance in pregnant women with obesity

OBJECTIVE

Introduction: Obesity is one of the most important medical and social problems in many countries of the world, as it is associated with the development of the most common non-communicable diseases: cardiovascular, type II diabetes mellitus, motor disorders, non-alcoholic fatty liver disease (NHAHP) and others. The aim of this paper is to analyze the pathogenetic mechanisms of insulin resistance development in pregnant women with varying obesity degrees in early and late gestation periods.

PATIENTS AND METHODS

Materials and methods: 459 pregnant women were examined at the Poltava City Clinical Maternity Hospital in the early (9-13 weeks) and late gestation periods (34-38 weeks). Metabolic disorders in pregnant women were studied by carbohydrate and lipid metabolism indices.

RESULTS

Results: Due to increased insulin resistance and reduced glucose absorption by tissues of pregnant women with obesity, there are prerequisites for the development of energy insufficiency. Obese women pregnancy runs on the background of hypertriglyceridemia and type IV hyperlipoproteinemia. The general pathogenic consequence of the insulin resistance progression during pregnancy in obese women is an energy deficiency increase, which causes a threatening obstetric and perinatal complications frequency increase.

CONCLUSION

Conclusions: The progression of insulin resistance during pregnancy of women with varying degrees of obesity is the pathogenetic basis of energy insufficiency and the reduction of adaptive mechanisms of pregnant women with obesity, as evidenced by the increase in obstetric and perinatal complications frequency.

Expression of resistin in the liver of patients with non-alcoholic fatty liver disease

Adipokines are cytokines that presumably connect the pathologies of metabolic syndrome. One of the adipokines is resistin, the role of which in insulin resistance, obesity, and non-alcoholic fatty liver disease (NAFLD) needs to be determined. Liver biopsy specimens were obtained intraoperatively from 214 obese patients. Histological assessment was based on NAFLD activity score according to Kleiner. Statistical analysis involved semi-quantitive immunohistochemistry assessment of resistin staining and: NAFLD status in obese patients compared with a non-obese control group, selected clinical data (age, sex, body mass index - BMI), selected biochemical data, comorbidities (hypertension, type 2 diabetes mellitus, dyslipidaemia), and metformin treatment in patients with type 2 diabetes mellitus. Resistin expression was observed in the histiocytes of inflammatory infiltrate, Kupffer cells, and histiocytes surrounding the hepatocytes with steatosis. There was a positive correlation between the total expression of resistin and: (1) NAFLD advancement (NAFLD Activity Score- NAS), (2) AST, ALT, BMI, glucose, insulin, Homeostasis Model Assessment (HOMA), LDH, GGT, triglycerides (TG), and glycated haemoglobin (HbA1c). Resistin expression was more intense in patients with type 2 diabetes mellitus and dyslipidaemia and less intense in the control group. Resistin probably plays a role in the pathogenesis of hepatic insulin resistance and aggravates pathologic changes in the liver of patients with NAFLD.

Effect of pioglitazone on insulin resistance, progression of atherosclerosis and clinical course of coronary heart disease

INTRODUCTION

Pioglitazone, a medication of thiazolidinedione group, is capable of triggering the peroxisome proliferator-activated receptors (PPAR-γ). Activation of receptor PPAR-γ regulates carbohydrate and lipid metabolism, immune and inflammatory responses in heart tissues.

THE AIM

Our aim was to study the effect of pioglitazone on insulin resistance, the clinical course of atherosclerosis and coronary heart disease (CHD).

MATERIALS AND METHODS

The study included 43 patients with coronary artery disease. Patients were divided into the main group - 20 patients, in whom pioglitazone (Pioglar, Ranbaxy, India) was included in the combined therapy at a dose of 15 mg 1 time per day in the morning, and the comparison group - 23 patients receiving standard complex drug therapy over 6 months. Patients underwent clinical examination, ultrasound of neck vessels, study of carbohydrate and lipid metabolism.

RESULTS

Joining pioglitazone to standard therapy resulted in the reduction of systolic (p<0.05) and diastolic (p<0.05) blood pressure; decrease in the duration of pain attacks (p<0.05); reduction in the frequency of angina attacks (p<0.05); regression of atherosclerosis of the carotid vessels (p<0.05), decrease in the thickness of the intima-media complex (p<0.05). The decline in oral glucose tolerance test (p<0.05), hyperglycemic factor (p<0.05), total cholesterol (p<0.05), and low density lipoproteins (p<0.05) were observed, as well as increased high-density lipoprotein (p<0.05).

CONCLUSION

Long-term treatment with pioglitazone at low doses against the background of standard therapy contributes to functional and clinical condition of patients, promotes the prevention of atherosclerosis and reduction of insulin resistance, thereby improving the clinical manifestations of coronary heart disease.

[Metabolic syndrome - a new look at a known problem]

Civilization changes over the past decades have been associated with an increase in the incidence of various metabolic disorders, especially in the carbohydrate-lipid metabolism, which are not always associated with obesity. Metabolic syndrome, despite changing criteria of recognition, is a clinically established risk factor for civilization diseases development. On the other side, the incidence of complex metabolic disorders in non-obese people is increasing, which is referred to in the literature as metabolic obesity with normal body mass. Both, excess visceral fatty tissue and insulin resistance are common components in the diagnosis of these syndromes and their occurrence is associated with an increased risk of developing type 2 diabetes and cardiovascular disease. Some researchers also point out the possibility of occurrence of so-called metabolically healthy obesity. Identify people with such a constellation of disorders is still difficult in clinical practice because of different and changing diagnostic criteria. Data from the literature about epidemiology of these disorders are inconclusive and do not allow for a reliable assessment of such disorders prevalence in population. The increasing rate of the metabolic syndrome and metabolic obesity with normal body weight occurrence in the general population pays attention to the importance of this problem, especially in primary health care. Preventive programs are primarily aimed at older people with high risk of cardiovascular diseases development and focused on detecting metabolic syndrome traits. Nevertheless, very often, young, potentially healthy individuals, are not subject to screening programs, even though incidence of metabolic obesity with normal body weight in this population is very high nowadays.