Opposite fates of fructose in the development of metabolic syndrome

This short review comments on the recently published work of Ishimoto et al regarding the opposing effects of fructokinase C and A isoforms on fructose-induced metabolic syndrome in mice. The framework for the commentary is the preexisting background of epidemiological and experimental data regarding the association between ingestion of fructose, as present in sweetened beverages, and the development of metabolic syndrome. The work of Ishimoto et al clearly confirms the negative effect of fructose on lipid and glucose metabolism, independently from the amount of energy provided by the ingested sugar. It also confirms the absolute requirement of liver fructose metabolism, driven by fructokinase activity, in order to develop the full spectrum of metabolic syndrome alterations.     

血脂代谢紊乱与腹膜透析置管大网膜包裹的关系

目的探讨血脂代谢紊乱和腹膜透析置管术后发生大网膜包裹的关系。方法选择中南大学湘雅医院肾内科收集腹膜透析置管术后发生大网膜包裹病例15例,以同期未发生大网膜包裹病例30例为对照,对比二组发生血脂代谢紊乱的差异。同时,以是否存在血脂代谢紊乱分组,对比腹膜透析置管术后大网膜包裹的发生率。结果大网膜包裹组的三酰甘油（TG）、胆固醇（CHO）和低密度脂蛋白（LDL）明显高于非大网膜包裹组;大网膜包裹组载脂蛋白A1（APOA1）水平则低于非大网膜包裹组。结论血脂代谢紊乱与腹膜透析置管术后发生大网膜包裹相关,可能是易于发生大网膜包裹的一个危险因素。     

中国北方人群血脂异常患病率及其影响因素分析的关系

目的调查中国北方人群血脂异常的患病率,并分析其影响因素。方法以参加2012年1月-2012年12月冀东油田社区健康体检的居民为调查人群,采用横断面调查的方法,分析人群中血脂异常的患病率及其影响因素。结果研究人群的一般情况:男性的年龄、体质指数、收缩压、舒张压、血总胆固醇、甘油三酯、低密度脂蛋白、空腹血糖高于女性,高密度脂蛋白胆固醇低于女性,不同性别组间比较差异有统计学意义(P<0.05);血脂异常患病率:研究对象血脂异常的总患病率为57.79%,其中男性患病率为66.34%。女性患病率为48.16%。血脂异常的logistic回归分析显示:男性、年龄增加、BMI升高、腹围增加、舒张压增加、血糖升高与血脂异常相关。结论中国北方人群血脂异常患病率逐渐增高且存在性别和年龄的差异,50岁以前男性高于女性,50以后女性明显增高甚至超过男性。男性、年龄增加、BMI升高、腹围增加、舒张压增加、血糖升高是血脂异常的独立危险因素。     

Endocrine side-effects of new anticancer therapies: Overall monitoring and conclusions

The present final consensus statement of the French Society of Endocrinology lays out the assessments that are to be systematically performed before and during anticancer treatment by immunotherapy, tyrosine kinase inhibitors or mTOR inhibitors, even without onset of any endocrinopathy. It also discusses the CTCAE adverse event grading system in oncology and the difficulty of implementing it for endocrine side-effects of these anticancer treatments. Notably, this is why certain treatment steps applied in other side-effects (e.g., high-dose corticosteroids, contraindications to immunotherapy, etc.) need to be discussed before implementation for endocrine side-effects.     

Expert opinion on the metabolic complications of mTOR inhibitors

Using mTOR inhibitors (mTORi) as anticancer drugs led to hyperglycemia (12–50%) and hyperlipidemia (7–73%) in phase-III trials. These high rates require adapted treatment in cancer patients. Before initiating mTORi treatment, lipid profile screening should be systematic, with fasting glucose assay in non-diabetic patients and HbA_1C in diabetic patients. After initiation, lipid profile monitoring should be systematic, with fasting glucose assay in non-diabetic patients, every 2 weeks for the first month and then monthly. The HbA_1C target is ≤ 8%, before and after treatment initiation in known diabetic patients and in case of onset of diabetes under mTORi. LDL-cholesterol targets should be adapted to general health status and cardiovascular and oncologic prognosis. If treatment is indicated, pravastatin should be prescribed in first line; atorvastatin and simvastatin are contraindicated. Fenofibrate should be prescribed for hypertriglyceridemia > 5 g/l resisting dietary measures adapted to oncologic status. In non-controllable hypertriglyceridemia exceeding 10 g/l, mTORi treatment should be interrupted and specialist opinion should be sought.     

Incidence,predictors, clinical profile,management and outcome of patients with isolated left main coronary artery ostial disease

ObjectivesIsolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease.Methods15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients.ResultsThe mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234).ConclusionIn one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.     

A study on the glycemic,lipid and blood pressure control among the type 2 diabetes patients of north Kerala,India

AimThe aim of the study was to detect the level of comprehensive diabetes control among the diabetic patients of Kerala, India.MethodsPatients (1200) were randomly selected from a diabetes care center. Their blood sugar, biochemical and anthropometric measurements were done and statistically analyzed.ResultsOnly 28.3% had their HbA1c at or below 7% and 45% above 9%. One-third of the female and one-fifth of the male patients had coronary artery disease. The prevalence of hypertension was almost equal in both sexes. However, there was a statistically significant higher systolic blood pressure (mean 162.12 mmHg vs 147.49 mmHg, p = 0.01044) among females. The total cholesterol was above 200 mg/dl in 42.1% of males and 45.61% of females. The triglyceride was >150 mg/dl in 38.6% males and 50.88% females. Low high density lipoprotein (HDL) cholesterol levels were found in 20.07% of males and 41.12% of females (p = 0.0445). The mean low density lipoprotein (LDL) was 121.75 (± 32.29)ConclusionThe mean blood sugar values are found to be high, which will lead to a predictable increase in vascular disease, which in turn will affect the quality of health and productivity of the individual and the economic growth of the society as a whole. Studies suggest that therapeutic interventions to improve glycemic control may reduce the risk of cardiovascular disease and microvascular disease.This study shows that the level of diabetes control in Kerala is unsatisfactory. We need more medications, better strategies and more emphasis on glycemic management than we are currently able to apply.     

Caracterização do perfil lipídico nos utentes dos cuidados de saúde primários em Portugal

AimTo characterize the distribution of total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides in primary health care users.MethodsWe performed a cross-sectional study in a primary care setting, involving 719 general practitioners based on stratified distribution proportional to the population density of each region of Portugal.The first two adult patients scheduled for an appointment on a given day were invited to participate. A questionnaire was applied to assess sociodemographic, clinical and laboratory data including lipid profile.ResultsThe study included 16 856 individuals (mean age 58.1±15.1 years; 61.6% women). Data on TC, LDL-C, HDL-C and triglycerides were available for 95.9% (n=16 159), 59.1% (n=9956), 95.4% (n=16 074) and 97.9% (n=16 494) of the population, respectively. Hypercholesterolemia (TC ≥200 mg/dl) was detected in 47%, and 38.4% had high levels of LDL-C (≥130 mg/dl). Hypertriglyceridemia (≥200 mg/dl) and low HDL-C (<40 mg/dl) were less prevalent, affecting roughly 13% of the population. Dyslipidemia was more common in middle-aged men and in post-menopausal women. Of the population aged over 40, 54.1% met eligibility criteria for lipid-lowering therapy and 44.7% were medicated with statins, but only 16.0% of these had TC ≤175 mg/dl.ConclusionsDyslipidemia is highly prevalent in primary health care users in Portugal. It is particularly common in middle-aged men and post-menopausal women, who should be considered target groups for preventive public health measures.