Frequency of insulin resistance in nondiabetic adult Bangladeshi individuals of different obesity phenotypes

Insulin resistance (IR) is the corner stone of metabolic obesity. This cross-sectional analytical study was aimed to find out the frequency of IR in non-diabetic adult individuals of different obesity phenotypes that would help to implement preventive measures to avoid the cardiometabolic catastrophes.MethodsTotal 955 nondiabetic adult individuals were selected and categorized into six metabolic phenotypes by metabolic syndrome criteria in each BMI group (18.5–24.9-normal weight, 25-29.9-overweight, ≥30-obese). From them, metabolically obese normal weight, metabolically obese overweight, metabolically healthy obese and metabolically unhealthy obese were selected as Obesity phenotypes (N = 616).ResultsThe frequency of IR was found to be very high (60.2%) in total nondiabetic adult obese individuals (N = 616). Highest frequency of IR was found in MUO phenotype (76.3%), lowest frequency of IR was found in MONW phenotype (37.1%) and frequency of IR in MOOW and MHO phenotypes found to be identical but significantly (p < 0.0001) less than MUO and significantly (p < 0.0001) more than MONW phenotype. Among the obesity phenotypes, females were more insulin resistant than males (67.5% vs 48.1% respectively, p < 0.05). Frequency of IR found significantly (p < 0.05) more in female than male in all obesity phenotypes except in MUO phenotype where males found to show significantly (p < 0.05) higher frequency than females. Frequency of IR was significantly higher in younger (20–39 yrs) age group than 40–60 yrs age group (63.2% vs 53.5% respectively, p < 0.05).ConclusionIR is alarmingly high (60.2%) in nondiabetic adult obese individuals. Among different obesity phenotypes, it is highest (76.3%) in MUO and lowest (37.1%) in MONW.     

10-Year Risk Equations for Incident Heart Failure in the General Population

BackgroundPrimary prevention strategies to mitigate the burden of heart failure (HF) are urgently needed. However, no validated risk prediction tools are currently in use.ObjectivesThis study sought to derive 10-year risk equations of developing incident HF.MethodsRace- and sex-specific 10-year risk equations for HF were derived and validated from individual-level data from 7 community-based cohorts with at least 12 years of follow-up. Participants who were recruited between 1985 and 2000, between 30 to 79 years, and were free of cardiovascular disease at baseline were included to create a pooled cohort (PC) and were randomly split for derivation and internal validation. Model performance was also assessed in 2 additional cohorts.ResultsIn the derivation sample of the PC (n = 11,771), 58% were women, 22% were black with a mean age of 52 ± 12 years, and HF occurred in 1,339 participants. Predictors of HF included in the race–sex-specific models were age, blood pressure (treated or untreated), fasting glucose (treated or untreated), body mass index, cholesterol, smoking status, and QRS duration. The PC equations to Prevent HF model had good discrimination and strong calibration in internal and external validation cohorts. A web-based tool was developed to facilitate clinical application of this tool.ConclusionsThe authors present a contemporary analysis from 33,010 men and women demonstrating the utility of the sex- and race-specific 10-year PC equations to Prevent HF risk score, which integrates clinical parameters readily available in primary care settings. This tool can be useful in risk-based decision making to determine who may merit intensive screening and/or targeted prevention strategies.     

Circulating glutamate level as a potential biomarker for abdominal obesity and metabolic risk

Background and aimCirculating level of glutamate, a by-product of the catabolism of branched-chain amino acids, has been positively correlated with visceral adipose tissue accumulation and waist circumference (WC). The aim of the present study was to assess the potential of using glutamate level to identify individuals with abdominal obesity and a high cardiometabolic risk.Methods and resultsThe study sample included 99 men and 99 women. Fasting serum glutamate was measured using the Biocrates p180 kit. Anthropometric and metabolic variables were used to identify individuals with abdominal obesity (WC ≥ 95 cm in both sexes), the hypertriglyceridemic waist (HTW) phenotype and the metabolic syndrome (MetS). Mean (±SD) age was 34.1 ± 10.1 years, mean BMI was 29.0 ± 6.2 kg/m² and mean WC was 92.7 ± 16.5 cm. Glutamate was strongly correlated with WC (r = 0.66 for men; r = 0.76 for women, both p < 0.0001) and multiple markers of metabolic dysfunction, particularly fasting triglyceride level (r = 0.59 for men; r = 0.57 for women, both p < 0.0001), HDL-cholesterol level (r = ?0.45, p < 0.0001 in both sexes) and the HOMA-IR index (r = 0.65 for men; r = 0.60 for women, both p < 0.0001). Logistic regressions showed that glutamate had an excellent accuracy to identify individuals with abdominal obesity (ROC_AUC: 0.90 for both sexes), a good accuracy to identify those with the HTW phenotype (ROC_AUC: 0.82 for men; 0.85 for women) and fair-to-good accuracy for the MetS (ROC_AUC: 0.78 for men; 0.89 for women).ConclusionGlutamate level may represent an interesting potential biomarker of abdominal obesity and metabolic risk.     

High-density lipoprotein cholesterol and objective measures of lower extremity performance in older nondisabled persons: the InChianti study

OBJECTIVES: To evaluate the independent association between high-density lipoprotein cholesterol (HDL-C) levels and objective measures of lower extremity performance.
DESIGN: Cross-sectional cohort study.
SETTING: Community-based.
PARTICIPANTS: Eight hundred thirty-six nondisabled women and men aged 65 and older enrolled in the Invecchiare in Chianti study.
MESASUREMENTS: Lower extremity performance was assessed using 4-m walking speed at fast pace, 400-m walking speed, and knee extension torque. Fasting HDL-C levels were determined using commercial enzymatic tests.
RESULTS: The mean age of participants was 73.7 (65–92), and 55.6% were women. After adjusting for potential confounders (sociodemographic factors, smoking, physical activity, body composition, and clinical conditions including cardiovascular and cerebrovascular disease, inflammatory markers, and serum testosterone) HDL-C levels were significantly associated with knee extension torque in men and women and with 4-m and 400-m walking speed in men. Men in the highest tertile of the HDL-C distribution (>55 mg/dL) had, on average, a three times greater probability of belonging to the best tertile of all indexes of lower extremity performance, including 4-m fast walking speed (odds ratio (OR)=2.57, 95%=confidence interval (CI)=1.07–6.17), 400-m walking speed (OR=3.74, 95% CI=1.20–11.7), and knee extension torque (OR=3.63, 95%=CI 1.41–9.33). Path analysis suggested a direct relationship between HDL-C and knee extension torque.
CONCLUSION: In older nondisabled persons, HDL-C levels are highly correlated with knee extension torque and walking speed. Further research should focus on the biological mechanism of this association.     

Hypertriglyceridaemia either in isolation or in combination with abdominal obesity is strongly associated with atherogenic dyslipidaemia in Asian Indians

Aim

To assess the prevalence of isolated hypertriglyceridaemia (iHTG) and hypertriglyceridaemic waist phenotype (HTWP) in urban adult Asian Indian population and to study their associations with atherogenic dyslipidaemia.

Methods

Data of an epidemiological survey (n = 2117, M:F 1007:1110) was used. Prevalences of iHTG (fasting triglycerides (TG) ≥ 1.7 mmol/l) and HTWP (waist circumference male ≥ 90 cm and female ≥ 80 cm and TG ≥ 1.7 mmol/l), were assessed. Their prevalences in relation to glucose intolerance were also studied. Associations of iHTG and HTWP with the occurrence of atherogenic dyslipidaemia indicated by elevated LDL-C/HDL-C ratio of ≥ 2.5 were assessed using multiple logistic regression analyses.

Results

iHTG, and HTWP were present in 13.4% and 17.8% respectively. Prevalence of HTWP was significantly higher among women. Prevalence of HTWP progressively increased with glucose intolerance. Nearly 60% of the subjects with iHTG or HTWP had atherogenic dyslipidaemia and prevalence was similar in both groups.

Conclusions

Hypertriglyceridaemia, present either as iHTG or HTWP was strongly associated with atherogenic dyslipidaemia. Dyslipidaemia occurred more frequently in glucose intolerance since the prevalence of both forms of hypertriglyceridaemia increased with glucose intolerance.     

Assessment of apoB dyslipoproteinemia in Korean population

Objectives

There is sparse data on apoB dyslipoproteinemia in Asian population. The purpose of this study was to assess apoB dyslipoproteinemia and to compare the LDL-C, non-HDL and apoB for risk assessment with percentile equivalent cut off in Korean population.

Methods

With 1193 Korean adult subjects, the prevalence and characteristics of different types of dyslipoproteinemias were analyzed in each age and gender group. The percentile values of direct LDL-C, calculated LDL-C, non HDL-C, HDL-C, apoAI, apoB and apoB/apoAI ratio were estimated.

Results

The prevalences of normoapoB–hyperTG, hyperapoB–normoTG and hyperapoB–hyperTG dyslipoproteinemia were 6.9, 8.9 and 10.9% in men and 3.7, 6.4 and 2.8% in women. The 40th percentile of direct LDL-C, calculated LDL-C, non-HDL-C and apo B were 108, 104.2, 126 and 85 mg/dl, respectively. The individual above optimal cut off was significantly underestimated with LDL-C than with non-HDL and apoB, in groups with adverse risk factors.

Conclusions

This study firstly shows the prevalence of various types of dyslipoproteinemias in Asian population. The percentile values of Korean population were similar to those of NHANES. Integration of lipid markers is needed for making clinical decisions and further research involving various populations and methodologies should be performed.     

GDF-15、HDL-C及cTnI检测联合CRUSADE评分在NSTE-ACS预后评估中的应用

目的探讨生长分化因子-15(GDF-15)、高密度脂蛋白胆固醇(HDL-C)及肌钙蛋白Ⅰ(cTnI)检测联合出血风险(CRUSADE)评分评估非ST段抬高的急性冠状动脉综合征(NSTE-ACS)预后的预测价值。方法选取2015年1月至2018年1月本院住院部治疗的102例NSTE-ACS患者设为观察组,根据CRUSADE评分分为低危组(n=34)、中危组(n=36)、高危组(n=32),选取同期110例体检的健康者为对照组。对比各组GDF-15、HDL-C及cTnI水平及不同预后的患者CRUSADE评分。随访3年,比较3组心肌缺血事件发生率、出血事件发生率及预后生存率,分析GDF-15、HDL-C及cTnI水平联合CRUSADE评分对NSTE-ACS患者预后死亡的预测价值。结果 GDF-15、cTnI水平:对照组<低危组<中危组<高危组,HDL-C水平:对照组>低危组>中危组>高危组,差异均有统计学意义(P<0.05)。高危组GDF-15及cTnI水平显著高于中危组及低危组,HDL-C水平明显低于中危组及低危组,差异有统计学意义(P<0.05),3组GDF-15、HDL-C及cTnI水平比较差异具有统计学意义(P<0.05)。高危组心肌缺血事件发生率、出血事件发生率均显著高于中危组及低危组,差异有统计学意义(P<0.05)。GDF-15及cTnI高表达、HDL-C低表达、CRUSADE评分≥41分的患者死亡率更高(P<0.05)。GDF-15、HDL-C、c TnI水平、CRUSADE评分及四者联合检测RCC曲线下面积分别为:0.839、0.803、0.876、0.938、0.978,各指标曲线下面积以联合检测最大。结论 NSTE-ACS患者GDF-15、HDL-C、cTnI水平呈异常表达状态,三者检测联合CRUSADE评分评估NSTE-ACS患者预后死亡的价值较高。     

三酰甘油/高密度脂蛋白胆固醇比值对青少年肥胖人群非酒精性脂肪性肝病的预测价值

目的:探讨三酰甘油/高密度脂蛋白胆固醇比值(TG/HDL-C)对肥胖青少年非酒精性脂肪性肝病(NAFLD)的预测价值。方法:选取2012年8月至2017年8月无锡市第二人民医院内分泌科门诊或住院的肥胖青少年患者共114例,收集腰围(WC)、体质指数(BMI)、血压(BP)、氢质子磁共振波普数据(~1H-MRS)、血清谷丙转氨酶(ALT)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)及胰岛素(INS)等临床指标,计算TG/HDL-C及稳态模型胰岛素抵抗指数(HOMA-IR)。结果:两组患者的年龄、性别、BMI、TC、腰围、舒张压、ALT和空腹血糖及胰岛素差异无统计学意义。高TG/HDL-C组患者收缩压和肝脏三酰甘油含量均显著高于低TG/HDL-C组(P0.05)。多因素Logistic回归分析提示:TG/HDL-C是青少年肥胖人群患NAFLD的独立危险因素(OR=5.78,95%CI 2.23～14.97)。TG/HDL-C预测青少年肥胖人群患NAFLD的ROC曲线下面积为0.73,以2.64为诊断界点时,灵敏度为72.5%,特异度为71.6%。结论:TG/HDL-C有助于预测肥胖青少年人群NAFLD的患病风险。     

NLR、PLR及LDL-C/HDL-C与急性冠脉综合症在院主要不良心脏事件的关联

【摘要】 目的 研究中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及低密度脂蛋白与高密度脂蛋白比值（LDL-C/HDL-C）与急性冠脉综合症（ACS）在院主要不良心脏事件的关系,探讨NLR、PLR、LDL-C/HDL-C对ACS患者在院主要不良心脏事件发生的预测作用。方法 将340例患者依据临床症状、辅助检查及冠脉造影分为正常对照组及ACS组,ACS组以临床诊断及预后分为UA组、NSTEMI组、STEMI组、MACEs组;ACS组又以NLR=5.44分为高NLR组、低NLR组,以PLR=129.70分为高PLR组、低PLR组,以LDL-C/HDL-C=2.75分为高LDL-CL/HDL-C组、低LDL-C/HDL-C组。检测外周血白细胞分类计数、血生化并计算NLR、PLR和LDL-C/HDL-C,应用SPSS 22.0软件进行统计分析。结果 （1）NLR在正常对照组、UA组、NSTEMI组、STEMI组、MACEs组中依次升高,且两组指标比较差异有统计学意义（P<0.05）;PLR值在正常对照组、UA组、NSTEMI组、STEMI组、MACEs组依次升高,且MACEs组、STEMI组与正常对照组及UA组差异具有统计学意义（P<0.05）;ACS患者LDL-C/HDL-C值高于正常对照组LDL-C/HDL-C值,且两组之间差异有统计学意义(P<0.05)。（2）高NLR组患者在院主要不良心脏事件发生率明显高于低NLR组,两组间差异有统计学意义（P<0.05）;高PLR组患者在院主要不良心脏事件发生率高于低PLR组,两组间差异有统计学意义（P<0.05）。（3）多因素Logistic回归分析显示年龄、高血压、NLR、LDL-C/HDL-C均是ACS的独立危险因素。结论 NLR、LDL-C/HDL-C是ACS的独立危险因素,NLR、PLR对ACS患者在院发生主要不良心脏事件有预测作用。     

血浆致动脉粥样硬化指数与2型糖尿病患者大血管病变的关系

目的探讨血浆致动脉粥样硬化指数(AIP)与2型糖尿病(T2DM)患者大血管病变的关系。方法选择90例2型糖尿病患者与20例正常对照者,2型糖尿病患者按有无大血管并发症分成两组测量身高、体重,计算体重指数(BMI),测量血压、血脂,计算AIP(指TG/HDL-C比值的对数值),并进行统计学处理。结果与正常对照组比较,T2DM组呈现出TG升高,HDL-C降低,AIP值明显升高,其中,AIP值变化最明显(P<0·001);T2DM组中,有大血管并发症与无大血管并发症相比,大血管并发症组BMI、TG、TC、HDL-C、LDL-C、AIP差异有显著性(P<0·05),其中,AIP值差异最显著(P<0·001)。结论AIP间接反映LDL-C颗粒直径的大小,可作为2型糖尿病患者发生大血管并发症危险性的一个指标。