Protein intake induced an increase in exercise stimulated fat oxidation during stable body weight

Background

Protein-rich weight-loss diets spare fat-free mass at the cost of fat mass. The objective was to examine if there is a change in stimulated fat oxidation related to protein intake during stable body weight.

Methods

Subjects' (BMI 22 ± 2 kg/m², age 25 ± 8 years) maximal fat oxidation (Fat_max) was assessed during a graded bicycle test, before and after a 3-month dietary-intervention of 2 MJ/day supplements exchanged with 2 MJ/d of habitual energy intake. The parallel design consisted of protein-rich supplements in the protein group and an isocaloric combination of carbohydrate and fat supplements in the control group. Daily protein intake was determined according to 24-h urine nitrogen. Body composition was measured according to a 4-compartment model by a combination of underwater-weighing technique, deuterium-dilution technique and whole-body dual-energy X-ray absorptiometry (DXA).

Results

Subjects were weight stable and did not change their physical activity. The protein group (n = 12) increased protein intake (11 ± 14 g, P < 0.05) and had significantly higher daily protein intake vs. control (n = 4) (80 ± 21 vs.59 ± 11 g, P < 0.05). Fat_max increased significantly in the protein group (0.08 ± 0.08 g/min, P < 0.01). Fat-free mass increased independent of change in body weight (P < 0.01), and fat mass and fat percentage decreased (P < 0.05). Change in Fat_max was a function of change in protein intake (r = 0.623, P < 0.05), and not of changes in body composition or VO₂max.

Conclusion

Increased stimulated fat oxidation was related to increased protein intake.     

Concentraciones de interleucina-18 en preeclámpticas y embarazadas normotensas sanas

Objective

To compare concentrations of interleukin-18 in pre-eclampsia patients and healthy normotensive pregnant women.

Method

A total of 100 patients were selected. Fifty pre-eclamptic patients were selected as cases (group A) and a control group selected by having the same age and body mass index to study group, consisting of 50 healthy normotensive pregnant women. Blood samples were collected in all patients before labour and immediately after diagnosis in group B to determine interleukin-18 concentrations.

Results

There were no significant differences in relation to maternal age, gestation age and body mass index at the time of taking the sample (P = ns). There was a statistically significant difference in interleukin-18 concentrations between patients in cases group (group A; 38.6 ± 6.5 pg/ml) and patients in control group (group B; 32.2 ± 8.5 pg/ml; P < .05). There was a moderate, positive and significant correlation with systolic blood pressure values (r = 0.341; P < .05) and with diastolic blood pressure values (r = 0.408; P < .05).

Conclusions

Pre-eclampsia patients had significantly higher concentrations of interleukin-18 when compared with healthy normotensive pregnant women.     

Innovative program to increase physical activity following an acute coronary syndrome: randomized controlled trial

Objective

To evaluate the impact of a socio-cognitive intervention associated with a pedometer-based program on physical activity, cardiovascular risk factors and self-efficacy expectation during one year following an acute coronary syndrome.

Methods

Sixty-five subjects were randomized during hospitalization in an experimental or a usual care group. Average steps/day was measured every 3 months until one year following discharge. Other dependent variables were measured at baseline, 6 and 12 months follow-up.

Results

There were 32 patients in the experimental group and 33 patients in the usual care group. Group characteristics were comparable. At baseline, averages steps/day were similar between groups (5845 ± 3246 vs. 6097 ± 3055 steps/day; p = 0.812). At 3-month follow-up, both groups increased their averages steps/day (p < 0.05). This increase was higher in the experimental group (3388 ± 844 vs. 1934 ± 889 steps/day; p < 0.001). At 12-month, interaction effects (group × time) in physical activity and waist circumference were different between groups (p < 0.05), whereas self-efficacy expectation increased in both groups similarly (p < 0.05).

Conclusion

The intervention is useful to improve average steps/day and waist circumference during the first year following an acute coronary syndrome.

Practice implications

This study supports development of the home-based cardiac rehabilitation program using socio-cognitive intervention associated with a pedometer after an acute coronary syndrome.     

Changes in body composition following a dietary and lifestyle intervention trial: The postmenopausal health study

Objective

To examine whether dietary changes and the consumption of dairy products fortified with calcium and vitamin D₃ versus the use of a calcium supplement alone could have any effect on anthropometric and body composition indices of postmenopausal women over a 12-month period.

Methods

101 healthy postmenopausal women were randomized to a dietary intervention group (DG: n = 39), receiving approximately 1200 mg of calcium and 7.5 μg of vitamin D₃ per day via fortified dairy products and attending biweekly dietary and lifestyle intervention sessions; a calcium supplemented group (CaG: n = 26) receiving a total of 1200 mg calcium per day; and a control group who continued with their usual diet (CG: n = 36). Dietary, physical activity, anthropometric, body composition and distribution (based on DXA) data were collected at baseline and after 12 months of intervention.

Results

No significant differences were observed in the mean 12-month changes in certain anthropometric (i.e. weight, BMI) and DXA (i.e. total body fat and lean mass) indices between groups. However, the DG was found to have a lower decrease in mid-arm muscle circumference (P < 0.001) and a lower increase in the sum of skinfolds’ thickness (P = 0.042) compared with the CaG and the CG. Furthermore, the DG was also found to have a greater decrease in the percentage of legs’ fat mass (P = 0.025) and a higher increase in the percentage of legs’ lean mass (P = 0.012) compared with the two other groups.

Conclusion

The application of a holistic intervention approach combining nutrition and lifestyle counseling with consumption of fortified dairy products for 12 months was found to have favourable changes in certain anthropometric and body composition indices compared to calcium supplementation alone.     

Disease-specific education in the primary care setting increases the knowledge of people with chronic obstructive pulmonary disease: A randomized controlled trial

Objective

To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in individuals recently diagnosed with chronic obstructive pulmonary disease (COPD).

Methods

A randomized control trial was undertaken during which an experimental group received 2 h of education delivered by a certified COPD educator and a control group received usual care. The Bristol COPD Knowledge Questionnaire (BCKQ) was self-administered at the time of randomization and approximately three months later.

Results

Of the 93 individuals that completed the study, 50 (forced expiratory volume in 1 s [FEV₁] = 60.0 ± 14.3% predicted; 22 males) and 43 (FEV₁ = 58.2 ± 14.4% predicted; 20 males) participants were randomized to the experimental and control groups, respectively. The BCKQ increased from 27.6 ± 8.7 to 36.5 ± 7.7 points (p < 0.001) in the experimental group, which was greater than any seen in the control group (between-group difference 8.3, 95% confidence interval 5.5-11.2 points).

Conclusion

As little as 2 h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge.

Practice implications

A program of brief education delivered in the primary care setting, represents an important approach for many individuals with COPD who are unlikely to access pulmonary rehabilitation.     

Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital

Objective

Determine treatment adherence in patients with multiple chronic conditions (MCC).

Methods

A random patient sample ≥15 years, discharged from hospital with ≥1 chronic conditions (CC) was interviewed after 6-12 months. Analysis included variables in 5 dimensions (WHO): socio-demographics, disease, treatment, patient and health system characteristics. Morisky-Green adherence questionnaire was used. High chronic treatment complexity was defined as: >3 pills/day, >6 inhalations/day, >1 injection/day, pharmacological treatment plus diet or self-monitoring techniques.

Results

301 patients were interviewed (62 ± 15 years, 59% males). Despite good treatment information perception (79%), only 3% followed the patient education programme. Poor adherents (82%) were older (64 ± 14 years vs. 55 ± 16 years), had more CC (3.25 ± 2.02 vs. 2.62 ± 2.72), a higher frequency of hypertension (44% vs. 15%), ischaemic heart diseases: (21% vs. 4%), hyperlipidaemia (19% vs. 6%), more pills/day (5.78 ± 4.14 vs. 3.20 ± 4.70) and more complex treatments (95% vs. 70%) (p < 0.05). On multivariate analysis number of CC [3.68 (0.75-18.15)], pills/day [2.23 (1.02-4.84)], treatment complexity [4.00 (1.45-11.04)], and hypertension [2.57 (1.06-6.25)] were predictive of poor adherence (OR 95% CI p < 0.05).

Conclusion

The WHO conceptual framework allows the construction of poor adherence risk profiles in patients with MCC after hospital discharge.

Practice implications

Predictive variables of poor adherence could help clinicians detect patients with MCC most likely to present poor adherence.     

Genetic associations with acute stress-related changes in eating in the absence of hunger

Background

Acute psychological stress is associated with eating in the absence of hunger.

Objective

To investigate if BclI and FTO polymorphisms are associated with eating in the absence of hunger as a result of acute psychological stress.

Methods

FTO (rs9939609) and BclI were genotyped in 98 subjects (BMI = 23.9 ± 3.3 kg/m²). In a randomized crossover design, the ‘eating in absence of hunger’ protocol was measured as a function of acute stress vs. a control task and of STAI (State Trait Anxiety Index) state scores.

Results

In comparison with the FTO T allele, the A allele was associated with an increased feelings of hunger after food intake in the stress (11 ± 10 vs. 18 ± 15, p < 0.01) and control condition (12 ± 9 vs. 16 ± 12, p < 0.05), even though food intake was not different. For the first time, it was observed that in comparison to the BclI C/C genotype, the BclI G/G genotype was associated with higher STAI states scores at 0, 10, and 20 min after the stress condition (30.8 ± 6.4 vs. 36.3 ± 8.2; 28.3 ± 5.5 vs. 32.3 ± 7.5; 27.7 ± 6.1 vs. 31.2 ± 7.5, p < 0.05). Additionally, the BclI G/G genotype was associated with a larger difference in energy intake between the stress and control condition, in comparison with the BclI C/C genotype (136.6 ± 220.4 vs. 29.4 ± 176.3 kJ, p < 0.04).

Conclusion

In concordance with previous studies, the FTO A allele is related to a lower feeling of hunger after a standardized meal. For the first time, the BclI G/G genotype is shown to be associated with increased sensitivity to psychological stress, and increased eating in the absence of hunger after stress.

Practice implications

Interventions to reduce body weight should consider the subjects’ genetic background.     

Development and validation of two equations estimating body composition for overweight and obese postmenopausal women

Objective

The aim of this study was to develop and validate two equations that best predict body composition of overweight and obese postmenopausal women.

Methods

Bioelectrical impedance analyses (BIAs) and anthropometric data such as circumferences and skinfolds were incorporated in the development of these two equations, respectively, while dual energy X-ray absorptiometry (DXA) was used as the reference method. A total number of 196 overweight and obese Greek postmenopausal women were used (131 subjects to develop the equations, and 65 to validate them).

Results

The BIA equation was: (FFM) = 38.475 + 0.207 × Wt − 0.092 × Rz/Ht² + 0.291 × Xc/Ht² (R² = 0.800, p < 0.0001) and the anthropometry equation was FM = −31.913 + 0.333 × GC + 0.840 × body mass index (BMI) + 0.064 × (biceps + triceps skinfold) (R² = 0.835, p < 0.0001). Both equations were found to result in unbiased estimates. Regarding reliability, BIA equation was found to be more reliable compared to existing ones when applied to this population. Additionally, BIA equation was more reliable compared to the anthropometric equation (±3.12642 kg vs. ±5.2342 kg limits of agreement, respectively).

Conclusion

These conclude that the equations developed in the current study are more reliable than the existing ones in the literature, and could be applied for assessing body composition in clinical practice and research.     

Metabolic transitions at menopause: In post-menopausal women the increase in serum uric acid correlates with abdominal adiposity as assessed by DXA

Objectives

The present study aimed to investigate any associations between parameters of body fat mass distribution and levels of serum uric acid (sUA), a well-documented cardiovascular risk factor, among non-obese women ranging from pre- to post-menopausal status.

Methods

In this cross-sectional population-based study we assessed body fat distribution by dual-energy-X-ray absorptiometry (DXA), and sUA levels in 101 pre- and 134 post-menopausal non-obese apparently healthy women.

Results

Multivariate stepwise regression analysis revealed that sUA was independently associated to the indicators of overall fatness, i.e. body mass index (β = 0.339, p < 0.001) and DXA-assessed total and percentage body fat (β = 0.366, p < 0.001 and β = 0.412, p < 0.001, respectively), only among post-menopausal women. Within this sample subset, trunk (i.e. central) fat mass emerged as a strong predictor of sUA (β = 0.408, p < 0.001), after taking the potential confounders (including body mass index) into account.

Conclusion

Central fat accumulation was found to be independently associated with higher sUA levels among non-obese women in post- but not among those in pre-menopause.     

Orange juice improved lipid profile and blood lactate of overweight middle-aged women subjected to aerobic training

Objective

This study investigated how consumption of orange juice associated with aerobic training affected serum lipids and physical characteristics of overweight, middle-aged women.

Methods

The experimental group consisted of 13 women who consumed 500 mL/d of orange juice and did 1 h aerobic training 3 times a week for 3 months. The control group consisted of another 13 women who did the same aerobic training program but did not consume orange juice.

Results

At the end of the experiment, the control group lost an average of 15% of fat mass (P < 0.05) and 2.5% of weight (P < 0.05), whereas the experimental group lost 11% of fat mass and 1.2% of weight (P < 0.05). Consumption of orange juice by the experimental group was associated with increased dietary intake of vitamin C and folate by 126% and 61% respectively. Serum LDL-C decreased 15% (P < 0.05) and HDL-C increased 18% (P < 0.05) in the experimental group, but no significant change was observed in the control group. Both groups improved the anaerobic threshold by 20% (P < 0.05), but blood lactate concentration decreased 27% in the experimental group compared to the 17% control group, suggesting that experimental group has less muscle fatigue and better response to training.

Conclusions

The consumption of 500 mL/d of orange juice associated with aerobic training in overweight women decreased cardiovascular disease risk by reducing LDL-C levels and increasing HDL-C levels. This association also decreased blood lactate concentration and increased anaerobic threshold, showing some improvement in the physical performance.     

Computerized self-monitoring and technology-assisted feedback for weight loss with and without an enhanced behavioral component

Objective

The purpose of this study was to develop and evaluate a 12-week weight management intervention involving computerized self-monitoring and technology-assisted feedback with and without an enhanced behavioral component.

Methods

120 overweight (30.5 ± 2.6 kg/m²) adults (45.0 ± 10.3 years) were randomized to one of three groups: computerized self-monitoring with Basic feedback (n = 45), Enhanced behavioral feedback (n = 45), or wait-list control (n = 30). Intervention participants used a computer software program to record dietary and physical activity information. Weekly e-mail feedback was based on computer-generated reports, and participants attended monthly measurement visits.

Results

The Basic and Enhanced groups experienced significant weight reduction (−2.7 ± 3.3 kg and −2.5 ± 3.1 kg) in comparison to the Control group (0.3 ± 2.2; p < 0.05). Waist circumference and systolic blood pressure also decreased in intervention groups compared to Control (p < 0.01).

Conclusions

A program using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral component did not improve the effectiveness of the program.

Practice implications

This study suggests that healthcare professionals can effectively deliver a weight management intervention using technology-assisted strategies in a format that may complement and reduce face-to-face sessions.     

Effects of a nutritional intervention in obese postmenopausal women on atypical antipsychotics

Objectives

To investigate the effects of a nutritional intervention on the body weight, body composition, blood glucose and lipid levels of obese postmenopausal women taking atypical antipsychotics in Greece.

Study design

In a case–control design, 25 obese postmenopausal women treated with antipsychotic medications and 28 obese healthy comparisons were followed for 3 months. A nutritional program was individually designed for each participant.

Main outcome measures

At baseline and at 3 months of the study, anthropometric, body composition, blood glucose and lipid measurements were performed.

Results

Significant reductions in body weight, body mass index (BMI), fat and waist circumference were found both in the patients and their healthy comparisons from baseline to 3 months (P < 0.05). Patients reduced significantly less their BMI (P = 0.044) and body fat percentage compared to the healthy women (P = 0.023). Waist circumference was significantly reduced in both subject groups, with no significant difference found between them (P = 0.07). Glucose and lipid levels were not altered during the intervention in the patients’ group, while significant changes were observed in the healthy women in total cholesterol (P = 0.016), low density lipoprotein cholesterol (P = 0.022) and triglycerides (P = 0.042).

Conclusions

Obese postmenopausal women on atypical antipsychotic medication appear to respond favorably to a nutritional program. The improvements seen in BMI and body fat are attenuated in the patients compared to their healthy counterparts; moreover no change in lipid levels was found in the patients’ group. These findings suggest that atypical antipsychotics may play an adverse role in fat loss and lipid metabolism in this population.     

A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: Improvement of quality of life

Objective

Physical and psychological incapacity, including fear of falling is related to decreased satisfaction with life in osteoporosis (OP). The impact of a balance exercise program on improving the quality of life is not well established. We have, therefore, investigated the effect of 12-month Balance Training Program in quality of life, functional balance and falls in elderly OP women.

Methods

Sixty consecutive women with senile OP were randomized into a Balance Training Group (BT) of 30 patients and no intervention control group (CG) of 30 patients. The BT program included techniques to improve balance over a period of 12 months (1 h exercise session/week and home-based exercises). The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Questionnaire (OPAQ), functional balance was evaluated by Berg Balance Scale (BBS). Falls in the preceding year were noted and compared to the period of study.

Results

The comparison of OPAQ variations (INITIAL–FINAL) revealed a significant improvement in quality of life in all parameters for BT compared to CG: well-being (1.61 ± 1.44 vs. −1.46 ± 1.32, p < 0001), physical function (1.30 ± 1.33 vs. −0.36 ± 0.82, p < 0.001), psychological status (1.58 ± 1.36 vs. −1.02 ± 0.83, p < 0.001), symptoms (2.76 ± 1.96 vs. −0.63 ± 0.87, p < 0.001), social interaction (1.01 ± 1.51 vs. 0.35 ± 1.08, p < 0.001). Of note, this overall benefit was paralleled by an improvement of BBS (−5.5 ± 5.67 vs. +0.5 ± 4.88 p < 0.001) and a reduction of falls in 50% in BT group vs. 26.6% for the CG (RR: 1.88, p < 0.025).

Conclusion

The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls.     

Autonomic function and change in insulin for exercising postmenopausal women

Purpose

Obesity, physical inactivity and altered estrogen metabolism play an integrated role contributing to the disease risk profiles of postmenopausal women. These same risk factors also affect modulation of the autonomic nervous system (ANS).

Methods

We examined 332 postmenopausal, overweight, previously sedentary women (mean ± SD; age, 57.6 ± 6.3 years; weight, 84.3 ± 11.9 kg; BMI, 31.7 ± 3.7 kg/m²) participating in a 6-month, moderate intensity, aerobic exercise training intervention to determine the relationship between heart rate variability (HRV) derived autonomic function and fasting insulin. We analyzed quartiles of change in time and frequency domain indices of ANS activity and changes in insulin for between and within group differences using ANCOVA and Tukey post hoc tests adjusted for age, ethnicity, randomization group, change in fitness, and change in weight.

Results

We observed at baseline that insulin was positively correlated with body anthropometry (body weight, r² = 0.34; BMI, r² = 0.39; waist circumference, r² = 0.29; all, P < 0.001), and inversely associated with rMSSD (r² = −0.12) and SDNN (r² = −0.18; all, P < 0.01). After the intervention, changes in rMSSD (r² = −0.21, P < 0.002) and SDNN r² −0.19, P < 0.0001) were inversely correlated to insulin change. Further ANCOVA analysis revealed that rMSSD and SDNN were both significant (P < 0.0001); however, only rMSSD exhibited a step-wise pattern of improvement when quartiles of rMSSD were compared to corresponding insulin reductions: Q1 (referent group, 8.41 ± 3.2 uIU/ml), Q2 (−3.30 ± −3.2 uIU/ml), Q3 (−5.66 ± −3.2 uIU/ml; P < 0.02), and Q4 (−9.60 ± −3.2 uIU/ml; P < 0.006).

Conclusion

Our study shows that changes in autonomic function are associated with changes in insulin and that exercise training may influence this relationship in postmenopausal women.     

Cyclic alternating pattern and sleep quality in healthy subjects—Is there a first-night effect on different approaches of sleep quality?

Objective

Cyclic alternating pattern (CAP) is defined as periodic EEG activity during NREM sleep that reflects unstable sleep and represents a marker of instability of the sleep process. The aim of the present investigation was to analyze sleep quality of 28 healthy subjects (mean age 53.3 ± 21.3 years) over two consecutive nights and determine potential differences between them (“first-night effect”).

Methods

Evaluations comprised objective and subjective sleep variables as well as macrostructural and microstructural variables of sleep.

Results

Macrostructural analysis showed significant differences between the first and the second sleep laboratory night in REM latency (122.39 ± 60.46 min vs. 95.43 ± 36.60 min; T = 3.431; p = 0.002) and the amount of sleep stage 1 (42.60 ± 21.80 min vs. 39.70 ± 18.95 min; T = 2.223; p = 0.035). Microstructural analysis revealed a significant decrease in the CAP rate (1st night: 33.29%; 2nd night: 26.34%; T = 3.288; p = 0.003) and in the amount of subtype A2 (74.79 ± 43.47 vs. 58.50 ± 23.22; T = 2.185; p = 0.038). Subjective variables also demonstrated a significant increase of drive (T = 2.564; p = 0.016).

Conclusion

Healthy subjects show hardly any macrostructural differences between the first and the second night in the sleep laboratory. On the microstructural level differences in CAP variables were found.

Significance

Microstructural analysis can be seen as a further approach to the classification of sleep and CAP turned out to be sensitive to environmental influences on sleep.     

Increased oxidative stress in dystrophin deficient (mdx) mice masticatory muscles

Background

It has been suggested that increased oxidative stress and the glutathione antioxidant system play an important role in the pathogenesis of Duchenne muscular dystrophy. However, there is still a lack of data about the oxidative status in dystrophic masticatory muscles.

Methods

In the masticatory muscles of the mouse model of Duchenne muscular dystrophy (mdx and controls; 100 days old, n = 8-10 each group) we examined the GSH and GSSG content (glutathione reduced/oxidized form) and the level of lipid peroxidation (LPO) as measured by the thiobarbituric acid-reaction.

Results

In the mdx mice masticatory muscles we found increased oxidative stress as compared to the controls. The GSH values in mdx muscles were decreased (mean ± SEM; masseter 339.8 ± 37.6 μg/g vs. 523.1 ± 36.1 μg/g, temporal 304.1 ± 49.6 μg/g vs.512.6 ± 60.6 μg/g, tongue muscle 243.3 ± 28.8 μg/g vs. 474.9 ± 40.1 μg/g; Fig. 1) as compared to normal mice. The GSH/GSSG ratio in mdx mice was consequently decreased. No significant differences in GSSG content and LPO levels were found between mdx and control mice.

Conclusions

The results imply that oxidative stress is present in all three studied mdx mouse masticatory muscles.     

Goal difficulty and goal commitment affect adoption of a lower glycemic index diet in adults with type 2 diabetes

Objective

Few studies have examined the effect of goal difficulty on behavioral change even though goal setting is widely used in diabetes education. The effect of a goal to consume either 6 or 8 servings/day of low glycemic index (LGI) foods was evaluated in this study.

Methods

Adults 40-65 years old with type 2 diabetes were randomly assigned to the 6 or 8 serving/day treatment group following a 5-week GI intervention. Perceived goal difficulty, commitment, satisfaction, and self-efficacy were evaluated, and four day food records assessed dietary intake.

Results

Both groups increased consumption of LGI foods (P < 0.001); there were no significant differences in the change in consumption between groups. Participants who were more committed to the goal perceived the goal to be less difficult (P < 0.01). Those with greater efficacy beliefs were more committed to their goal, perceived the goal to be less difficult, and were more satisfied with their performance (all P < 0.05).

Conclusion

A specific goal regarding LGI foods can facilitate the adoption of a lower GI diet. Future research is needed to determine if goal commitment or goal difficulty mediate the process.

Practice implications

Clinicians should help clients set specific goals regarding dietary change.     

Phenotypic characterization of the infiltrating immune cells in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma

Background

Immune cell infiltrate is a constant feature in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma. This study elaborates on the cells of the immune system present in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma.

Hypothesis

Here, we hypothesized that “the development of benign nodular prostatic hyperplasia and prostatic adenocarcinoma is associated with numeric alterations of the immune cell infiltrate”.

Materials and methods

A total of 50 transurethral prostatic resection specimens, each entailing normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma were evaluated for the density and phenotype of the immune cells using immunohistological methods and mouse monoclonal antibodies decorating T cells (CD3), histiocytes (CD68) and B lymphocytes (CD20).

Results

Immune cell infiltrate was composed of T cells, histiocytes and B-lymphocytes. CD⁺3 T lymphocytes and CD68⁺ cells were the predominant cell populations. We observed variations in the density of the immune cells among the normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma. Compared with normal prostate, benign nodular prostatic hyperplasia had a statistically significant high density of immune cells (3.4 ± 0.4versus 13.5 ± 1.0, P < 0.00). In contrast, a significant decrease in the counts of these cells was observed in high-grade prostatic adenocarcinoma compared to benign nodular prostatic hyperplasia (13.5 ± 1.0 versus 5.2 ± 0.3, P < 0.01).

Conclusions

The increased density of immune cells (predominantly CD⁺3 T cells) in benign nodular prostatic hyperplasia suggests that the initial response to cellular damage is mediated by cell-mediated immunity. The decreased density of immune cells in high-grade prostatic adenocarcinoma may reflect immunosuppression. The underlying mechanisms of these numeric variations are open for further investigations.     

Menopause is an independent predictor of metabolic syndrome in Iranian women

Background

Gender differences in prevalence and consequences of the metabolic syndrome as a strong predictor of cardiovascular disease (CVD), are challenging problems. Postmenopausal status may explain in part the cause of acceleration of CVD with aging. The purpose of this study was to investigate the relation of menopause and metabolic syndrome independent of aging among Iranian women.

Methods

On the basis of consecutive recruitment, 940 women between 20 and 76 years old participated in the study. Anthropometric indices, fasting blood glucose, lipid profile were measured, Framingham risk score and homeostasis model assessment (HOMA-IR) were calculated for all participants. The metabolic syndrome (MetS) was defined according to the National Cholesterol Education Program Adult Treatment Panel III. We used IDF definition for metabolic syndrome modified by our recent local data as an alternative measurements.

Results

The overall prevalence of metabolic syndrome was 26.4%. Its prevalence was 53.5% in postmenopausal versus 18.3% in premenopausal women. On binary logistic regression analysis, HOMA index, body mass index, waist to hip ratio, family history of diabetes and hypertension had an independent and significant effect on metabolic syndrome. Age-adjusted odds ratio (OR) of postmenopausal status for metabolic syndrome was 2.85 (95%CI: 1.31–6.20) (P < 0.008). Framingham risk score was 8.3 ± 7.7 in MetS+ve cases versus 1.9 ± 2.1 in MetS−ve cases (P < 0.001). There were significant differences between Framingham risk score in postmenopause 9.1 ± 6.4 versus premenopause 1.6 ± 1.6 (P < 0.001). A significant correlation was found between Framingham risk score and body mass index, waist to hip ratio, HOMA-IR and components of metabolic syndrome (P < 0.001). Forty percent of participants with premature menopause had metabolic syndrome versus 24% in age-matched group and Framingham risk score was significantly higher than normal cases 5.4 ± 4.9 versus 2.0 ± 2.3 (P < 0.001).

Conclusion

Menopausal status can be a predictor of metabolic syndrome independent of age in Iranian women. Menopause is a process closely related to insulin resistance and cardiovascular risk factors.     

Role of hepatic HCV-RNA level on the severity of chronic hepatitis C and response to antiviral therapy

Background

Correlation between hepatic HCV-RNA and serum HCV-RNA, severity of liver disease and response to therapy is poorly known.

Objectives

To assess the influence of hepatic HCV-RNA level on severity of liver disease and response to therapy in a large cohort of chronic hepatitis C (CHC) patients.

Study Design

HCV-RNA was measured in frozen liver biopsies and serum samples from 130 CHC patients the day of liver biopsy prior to treatment. Liver fibrosis was assessed by Ishaq scoring. A Sustained Virological Response (SVR) was observed in 52% of the patients, non-response (NR) in 34%.

Results

Mean ± standard deviation hepatic HCV-RNA level was 7.69 ± 0.67 log₁₀ copies/mg of liver. Mean serum HCV-RNA level was 6.21 ± 0.72 log₁₀ copies/ml. There was a correlation between hepatic and serum HCV-RNA in genotype 1 and 4 (p = 0.008 and p = 0.03) and age (p = 0.006). Mean hepatic HCV-RNA was 7.70 ± 0.69 vs 7.67 ± 0.68 log₁₀ copies/mg of liver, in patients with significant fibrosis vs those with mild fibrosis, respectively (p = 0.7); 8.04 ± 0.68; 7.44 ± 0.47; 7.43 ± 0.49 and 7.44 ± 0.71 log₁₀ copies/mg of liver in genotypes 1, 2, 3 and 4, respectively (p = 0.0001); higher in women than in men (p = 0.04); 7.60 ± 0.63, 7.71 ± 0.54 and 7.96 ± 0.73 log₁₀ copies/mg in SVR, relapsers and NR, respectively (p = 0.1). Multivariate analysis showed that high hepatic HCV-RNA level was independently associated with genotype and response to therapy was associated with genotype independently from hepatic HCV-RNA level.

Conclusions

Hepatic HCV-RNA level was not associated with severity of liver disease. High level was strongly associated with HCV genotype independently from response to therapy.