Journal of Metabolic Syndrome

Objective: Metabolic syndrome (MS) also known as insulin resistance syndrome is a surrogate marker of insulin resistance (IR). Traditionally this is being diagnosed by Adult Treatment Panel III (ATP-III) and International Federation of Diabetes (IDF) criteria. Despite mounting evidence in favor of non-alcoholic fatty liver disease (NAFLD), this has not been yet included as a component of either ATP-III or IDF criteria. We conducted this study to evaluate if NAFLD could be used as a criterion for identifying metabolic syndrome.

Methods: Setting: Single center observational study in Gastroenterology OPD at SCB Medical College, Cuttack. Subjects: Consecutive subjects presenting with functional bowel disease were included; these included 68 NAFLD subjects and 200 subjects with normal liver on ultrasonography. Investigations: All 268 subjects were evaluated for the presence of metabolic syndrome by ATP-III and insulin resistance by HOMA IR method. NAFLD subjects were compared with those with metabolic syndrome for presence of insulin resistance

Results: Patients with NAFLD had higher HOMA-IR than those with metabolic syndrome (2.34±1.01 vs. 1.79±1.01; p<0.000). Presence of NAFLD can detect insulin resistance with a sensitivity of 78.0% and specificity of 86.3 % with an odds ratio of 25.55 (95%CI: 11.51-56.70) which is better than that of metabolic syndrome diagnosed by ATP-III criteria (sensitivity 71.43%, specificity 70.32%; OR: 5.92, 95%CI: 2.99-11.74). Multivariate logistic regression analysis showed that fatty liver was an independent predictor for insulin resistance and metabolic syndrome.

Conclusion: NAFLD alone is a better predictor for insulin resistance than existing ATP-III criteria. Hence NAFLD should be used as a surrogate marker for metabolic syndrome.

Objectives: Some pathological situations of female reproductive life predispose mother and offspring to higher risk of development of metabolic syndrome. Therefore, we aimed to assess relationships between all significant medical and gynecologic/pregnancy-related antecedents and metabolic syndrome components in menopausal women.

Study design: During a cross-sectional study carried out from August 2014 to January 2015, medical, gynecological and pregnancy-related history was obtained from menopausal women followed for metabolic syndrome at the University of Kinshasa Hospital. Metabolic syndrome was defined as the presence of at least 3 out of 5 criteria according to harmonized definition. Using logistic regression analysis we evaluated the association between history characteristics and metabolic syndrome components (p<0.05 as significant).

Results: 42 menopausal women were consecutively enrolled. Dominating characteristics were family history of hypertension (FH-HT) and diabetes mellitus (FH-DM), personal antecedents of spaniomenorrhea, pregnancyassociated urinary tract infection (UTI), premature delivery, pregnancy-induced hypertension (PIHT), gestational diabetes mellitus (GDM), macrosomia, stillbirth and congenital malformations. Significant associations (OR; p) were FH-HT with abdominal obesity (6.2; 0.008) and hypertriglyceridemia (4.9; 0.018); FH-DM with abdominal obesity (55.2; 0.000), hypertriglyceridemia (12.2; 0.001) and low HDL (1.8; 0.02); spaniomenorrhea with obesity (14.8; 0.004), HBP (9.8; 0.018) and hypertriglyceridemia (12.9; 0.006). For obstetrical history the picture was: PIHT with abdominal obesity (24; 0.000) and hypertriglyceridemia (8.2; 0.008); GDM with hypertriglyceridemia (11; 0.012); premature delivery with obesity (4.3; 0.04) and HBP (13; 0.006); stillbirth with HBP (7.2; 0.048) and low HDL (12.1; 0.009); macrosomia with obesity (15.9; 0.000) and hypertriglyceridemia (6.9; 0.008).

Conclusion: Apart from known medical risk factors, past spaniomenorrhea emerged as the main gynecological factor whereas premature delivery, gestational diabetes, PIHT, infant’s macrosomia, stillbirth and congenital malformations were obstetrical ones associated with components of MS. They are likely to permit early detection and management of MS. 

Objective: Apelin and its specific receptor, APJ system, seems to be involved in the development of arterial hypertension (HTN). The aim was to estimate plasma apelin concentration in young patients (pts) with primary HTN and to assess the relationship between apelin and selected anthropometric parameters, serum lipids and carotid intima-media thickness (right and left cIMT).

Methods: 70 pts (48 males, 22 females) aged 18-33 with newly diagnosed, untreated primary HTN were recruited. There were 15 age- and gender-matched healthy people in the control group. Anthropometric and BP measurements were done. Fasting serum apelin and lipids were evaluated. The cIMT was estimated using ultrasonography.

Results: Serum apelin was higher in whole group (but not statistically significant, 98.04 ± 51.82 vs. 79.19 ± 39.51 pg/ml, p >0.05) and in males with HTN (compared to healthy males, 105.86 ± 53.21 vs. 61.42 ± 24.04 pg/ ml, p= 0.04). We observed a statistically significant negative correlation between apelin concentration and left cIMT in normal-weight women (R = -0.74), a negative correlation between triglyceride levels and apelin concentration in overweight subjects (R = -0.49), a negative correlation between apelin concentration and right cIMT (R = -0.99) and a positive correlation between apelin concentration and WHR (R = 0.99) in obese women.

Conclusion: In whole examined group with HTN there were no statistically significant differences in serum apelin and no relationships between its concentration and anthropometric parameters, serum lipids or cIMT. However, higher serum apelin concentration in young males with HTN and some statistically significant correlations between serum apelin and analyzed parameters in groups divided by sex and BMI may suggest a possible role of apelin in the development of HTN. Further studies are required to clarify the relationship between apelin, metabolic parameters and the early markers of atherosclerosis in pts with HTN.

Objective: This study aimed to evaluate the metabolic syndrome among Mbo ethnic group women living in Yaounde, Cameroon.

Methods: The study was conducted on ninety-two women aged between 18-60 years who were referred to the Andre Fouda Medical Fundation in Yaounde. Metabolic syndrome was diagnosed using Adult Treatment Panel-III (ATPIII) 2001 guidelines.

Results: The mean of age, high fasting blood glucose, triglycerides levels and total cholesterol levels were significantly (p<0.05) higher in women with metabolic syndrome. The overall prevalence of metabolic syndrome among Mbo women was (3.03%). High blood pressure level (43.93%) and high fasting glucose (14.39%) were respectively the most frequent characteristics in comparison to other metabolic components. 3.03%, 0% and 0% had three, four and five criteria for metabolic syndrome, respectively.

Conclusion: The prevalence of metabolic syndrome is low in women originates of Mbo ethnic group of Yaounde. For efficient measures to limit the rise of cardiovascular diseases in these women, both hypertension and hyperglycaemia should be taken into consideration. 

Background: Owing to the proposal of the increase of oxidative stress (OxS) as an early event in the development of the metabolic syndrome (MetS), the aim of the present study was to evaluate certain OxS biomarkers in patients with MetS compared to healthy people age-matched and younger to assess the relevance of aging in OxS and MetS.

Methods: A total of 72 patients, 32 who fulfilled the Adult Treatment Panel III criteria for the MetS and 40 individuals without MetS, 20 age-matched to the MetS patients (Control I) and 20 younger subjects (Control II) were studied. We measured several anthropometric and serum parameters and two kinds of molecules related to OxS: modified molecules by reactive oxygen species (ROS) such as oxidized LDL (oxLDLc), and consumed or inducted molecules (enzymes or antioxidants such as Glutathione reductase GR,) associated with ROS metabolism. The statistical analysis was performed using SPSS v18.0.

Results: Only significant differences were observed in the values of GR between the MetS patients and Control I (50.31 ± 8.15 U/L vs 59.50 ± 9.98 U/L). We found significantly higher levels in the MetS patients compared to Control II of oxLDLc (96.77 ± 23.05 U/L vs 60.17 ± 16.28 U/L), F2 -isoprostanes (3.17 ± 1.78 µg/g creatinine vs 2.04 ± 0.80 µg/g creatinine) and protein cabonils (PC) (0.56 ± 0.26 nmol/mg vs 0.29 ± 0.13 nmol/mg).

Conclusions: Results have shown that MetS patients don’t present a superior OxS in comparison to age-related healthy individuals. Finally, aging is more relevant to OxS than MetS per se. 

Background: Obesity increases the incidence of diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Oxidative stress has been considered one of the mechanisms linking obesity to these pathologies. Our aim was to evaluate the oxidative stress status in obese Adults

Methods: Our study focused on a sample of 187 healthy volunteers in the city of Constantine, divided according to their BMI into three groups: group A (BMI <25, normal nutritional status), group B (25 ≤ BMI <30, overweight) and group C (BMI ≥ 30, obesity). The status of oxidative stress was evaluated by determining the activities of erythrocyte antioxidant enzymes glutathione peroxidas (GPx) and superoxide dismutase (SOD), plasma concentrations of antioxidant vitamins (E,A) and lipid peroxidation marker , the malondialdehyde (MDA).

Results: Vitamin E / Lipids ratio and vitamin A plasma concentration were significantly lower in obese subjects compared with those having normal BMI: 3.40 ± 1.16 mg / g vs 3.87 ± 1.16 mg / g; p <0.05 and 0.63 (0.46-0.76) mg/l vs 0.69 (0.57-0.86) mg/l, p <0.05 respectively. MDA plasma concentrations were significantly higher in obese versus overweight subjects and those having normal BMI: 11.4 (7.1 to 14.6) mg/l vs 8.6 (5.9 to 11.6) g/l, p <0.01 and 11.4 (7.1 to 14.6) mg/l vs 8.4 (5.9 to 12.3) mg/l, p <0.05 respectively. There was no significant difference between the MDA plasma concentration of overweight subjects and those having normal BMI. Erythrocyte SOD and Gpx activities of different classes of BMI were comparable. MDA was positively and significantly correlated with BMI (r = 0.149, p <0.05). Conclusion: The decrease in antioxidant defenses and increased lipid peroxidation in obese subjects reflect a profound oxidative stress, which would be one of the mechanisms involved in the onset of diseases caused by the obesity.

Objective: Metabolic syndrome entails hypertension, hyperglycemia, obesity and hypercholesterolemia. This syndrome increases the risk of cardiovascular disease and diabetes. Hyperglycemia during coronary reperfusion is associated with a poor prognosis. Contrastingly, targeting correction of hyperglycemia in clinical trials has not improved clinical outcome or has even been detrimental. H2O2 is produced under hyperglycemic conditions and under reperfusion. This study aims to provide a mechanistic approach evaluating the impact of high glucose on the endothelial nitric oxide pathway in a H2O2 -rich environment.

Methods and results: HUVECs (human umbilical vein endothelial cells) were exposed to high glucose (20 mM) for either 20 or 72 hours co-incubated with or without H2O2 (400 µM) for 30 minutes as models of increased oxidative stress during acute and prolonged hyperglycemia, respectively. The presence of reactive oxygen species (ROS) in both mitochondria and cytoplasm was measured by fluorescence activated cell sorting (FACS). Phosphorylation of endothelial nitric oxide synthase (eNOS) on threonine 495 (Thr495) and serine 1177 (Ser1177) was assessed by western blotting. Short-term (20 hours) high concentration of glucose alone increased ROS in mitochondria to 133.5% (p<0.05), whereas prolonged (72 hours) did not increase mitochondrial ROS. The increase in mitochondrial ROS could be attenuated by the anti-oxidant N-acetyl-L-cysteine (NAC). Incubation with H2O2 for 30 minutes resulted in an increase in Thr495 phosphorylation (to 425%, p<0.01) and a decrease in Ser1177 phosphorylation (to 50.6%, p<0.01). Preincubation for 20 hours with 10 and 20 mM glucose did not affect phosphorylation of Thr495 and Ser1177. Stimulating HUVECs that were pre-incubated with 20 mM glucose for 72 hours with H2O2 increased Thr495 phosphorylation to 146.6% (p<0.05). PKC inhibition attenuated the H2O2 -induced Thr495 phosphorylation in cells incubated with high glucose levels for 72 hours.

Conclusion: Acute exposure to high glucose induces oxidative stress. H2O2 leads to phosphorylation of eNOS at Thr495 and dephosphorylation of Ser1177. After prolonged exposure to high glucose levels, the addition of H2O2 yields phosphorylation of Thr495 through the PKC pathway

Atypical antipsychotics are associated with weight gain, which compromise medication adherence and pose longterm health complications. These are two cases in which lorcaserin, a 5HT2C agonist, has been used to counteract olanzapine-induced weight gain in conjunction with a low carbohydrate diet. In Case 1, patient lost a significant amount of weight and reported decreased food cravings. In Case 2, patient showed initial response but was unable to maintain diet. Patient had significant weight gain and reported increased cravings after discontinuing lorcaserin. These cases demonstrate 5HT2C agonists’ potential for management of atypical antipsychotic-related weight gain.