Relationships between fasting plasma insulin, anthropometrics, and metabolic parameters in a very old healthy population. Associazione Medica Sabin

Long-term risk of acute coronary syndrome in patients with cholangitis: a 13-year nationwide cohort study

BACKGROUND & AIMS

Patients with cholangitis may exhibit repeated and chronic inflammation of the biliary tract despite successful medical or surgical treatments. This nationwide cohort study examined the association between cholangitis and the subsequent development of acute coronary syndrome (ACS).

METHODS

We identified a cohort of 37676 patients who were diagnosed with cholangitis between January 1998 and December 2010, and a comparison cohort of 150704 subjects frequency matched by age, sex, and index year after excluding comorbidities for ACS. Both cohorts were followed until the end of 2010 to measure the incidence of ACS. Both incidence rate ratios and hazard ratios of ACS were estimated by age and sex.

RESULTS

Sex-specific analysis showed that males were at a higher incidence of ACS than females in both groups with (16.2 vs 11.5 per 10,000 person-years) and without (18.7 vs 12.5 per 10,000 person-years) cholangitis. The incidence of ACS also increased with age no matter having or not having cholangitis. The age stratified analysis revealed that the risk of ACS was significantly higher in patients with cholangitis younger than 65 years old. The multivariable Cox proportional hazard model demonstrated that cholangitis was significantly associated with ACS (adjusted hazard ratio [HR]=1.18; 95% confidence interval [CI], 1.03-1.35) after adjusting age and sex in the model.

CONCLUSIONS

This study suggests that patients with cholangitis are at an elevated risk of ACS. Awareness of the potential ACS risk for patients with cholangitis is important for patients and clinicians.

Neuroinflammatory basis of metabolic syndrome

Inflammatory reaction is a fundamental defense mechanism against threat towards normal integrity and physiology. On the other hand, chronic diseases such as obesity, type 2 diabetes, hypertension and atherosclerosis, have been causally linked to chronic, low-grade inflammation in various metabolic tissues. Recent cross-disciplinary research has led to identification of hypothalamic inflammatory changes that are triggered by overnutrition, orchestrated by hypothalamic immune system, and sustained through metabolic syndrome-associated pathophysiology. While continuing research is actively trying to underpin the identity and mechanisms of these inflammatory stimuli and actions involved in metabolic syndrome disorders and related diseases, proinflammatory IκB kinase-β (IKKβ), the downstream nuclear transcription factor NF-κB and some related molecules in the hypothalamus were discovered to be pathogenically significant. This article is to summarize recent progresses in the field of neuroendocrine research addressing the central integrative role of neuroinflammation in metabolic syndrome components ranging from obesity, glucose intolerance to cardiovascular dysfunctions.

Obesity and inflammation: epidemiology, risk factors, and markers of inflammation

Obesity is a public health problem that has reached epidemic proportions with an increasing worldwide prevalence. The global emergence of obesity increases the risk of developing chronic metabolic disorders. Thus, it is an economic issue that increased the costs of the comorbidities associated. Moreover, in recent years, it has been demonstrated that obesity is associated with chronic systemic inflammation, this status is conditioned by the innate immune system activation in adipose tissue that promotes an increase in the production and release of pro-inflammatory cytokines that contribute to the triggering of the systemic acute-phase response which is characterized by elevation of acute-phase protein levels. On this regard, low-grade chronic inflammation is a characteristic of various chronic diseases such as metabolic syndrome, cardiovascular disease, diabetes, hypertension, non-alcoholic fatty liver disease, and some cancers, among others, which are also characterized by obesity condition. Thus, a growing body of evidence supports the important role that is played by the inflammatory response in obesity condition and the pathogenesis of chronic diseases related.

Decreased insulin sensitivity and increased oxidative damage in wasting adipose tissue depots of wild-type mice

Unintentional weight loss (wasting) in the elderly is a major health concern as it leads to increased mortality. Several studies have focused on muscle loss, but little is known about the mechanisms giving rise to loss of fat mass at old ages. To investigate potential mechanisms, white adipose tissue (WAT) characteristics and proteomic profiles were compared between adult (10-12-month-old) and aged (22-24-month-old) wild-type mice. Four individual WAT depots were analyzed to account for possible depot-specific differences. Proteomic profiles of WAT depots, along with body weights and compositions, plasma levels of insulin, leptin and adiponectin, insulin tolerance, adipocyte sizes, and products of oxidative damage in each WAT depot were determined. We found that lean mass remained constant while fat mass and insulin tolerance were decreased in old age, as were adipocyte sizes in the WAT depots. Proteomic results showed increased levels of enolase, pyruvate dehydrogenase E1β, NAD(+)-dependent isocitrate dehydrogenase α, and ATP synthase subunit β, and decreased levels of carbonic anhydrase 3 in WAT of aged mice. These data suggest increased aerobic glucose oxidation in wasting WAT, consistent with decreased insulin signaling. Also, Cu/Zn superoxide dismutase and two chaperones were increased in aged WAT depots, indicating higher stress resistance. In agreement, lipid peroxidation (HNE-His adducts) increased in old age, although protein oxidation (carbonyl groups) showed no increase. In conclusion, features of wasting WAT were similar in the four depots, including decreased adipocyte sizes and alterations in protein expression profiles that indicated decreased insulin sensitivity and increased lipid peroxidation.

Effect of testosterone replacement treatment in testosterone deficiency syndrome patients with metabolic syndrome

Purpose

This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome.

Materials and Methods

We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured.

Results

In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT.

Conclusions

Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.

Gender-specific correlations of plasminogen activator inhibitor-1 and tissue plasminogen activator levels with cardiovascular disease-related traits

BACKGROUND

The purpose of this study was to examine the correlations between plasma levels of plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (t-PA) and cardiovascular disease-related traits in a general population and whether these correlations differed between females and males.

METHODS

Plasma PAI-1 and t-PA antigen levels and C-reactive protein (CRP), HDL-cholesterol, triglycerides, total cholesterol, systolic blood pressure, diastolic blood pressure, urinary albumin excretion, and glucose were measured in the population-based PREVEND study in Groningen, the Netherlands (n = 2527).

RESULTS

Except for CRP and total cholesterol levels, all traits were significantly different between gender (P < 0.001). PAI-1 levels were correlated with all measured cardiovascular disease-related traits (P < 0.01) in both females and males. Except for urinary albumin excretion, similar results, albeit less significant, were found for t-PA levels. Age-adjusted correlations between PAI-1 and CRP, triglycerides, total cholesterol, systolic blood pressure, and diastolic blood pressure differed significantly between females and males (P < 0.01). Many of the gender differences were predominantly present between premenopausal females and males.

CONCLUSION

PAI-1 and t-PA levels were correlated with cardiovascular disease-related traits in subjects obtained from the general population and several of these correlations differed across gender. The correlations found in the present study suggest the presence of coordinated patterns of cardiovascular risk factors and indicate which traits might influence PAI-1 and t-PA levels and thereby provide a framework and potential tool for therapeutic intervention to reduce thromboembolic events in the general population.

Association of hematological factors with components of the metabolic syndrome in older and younger adults

BACKGROUND AND AIMS

This study retrospectively examined the characteristics of metabolic syndrome in an aged population and assessed the risk factors for these subjects.

METHODS

A total of 1332 aged subjects (> or =65 years; mean age 71.0+/-5.0 years) were enrolled from 6903 subjects recruited from the Department of Health Management at Chang Gung Medical Center. Of these 6903 subjects, 1665 (814 females and 851 males) were diagnosed with metabolic syndrome. Whole body three-dimensional (3- D) laser scanning was employed for anthropometric measurements. Furthermore, health index (HI) was derived by the following equation: HI = (body weight x 2 x waist area) / [body height2 x (breast area + hip area)].

RESULTS

Among the 6903 subjects, no significant difference in gender was noted between groups with and without metabolic syndrome (p=0.142). For subjects >64 years, the incidence of metabolic syndrome in females is higher than in males. Subjects are categorized into four groups based on age and whether they had metabolic syndrome. Group A (4402 cases) consists of subjects <65 years old without metabolic syndrome. Group B (836 cases) comprises subjects >64 years old and without metabolic syndrome. Group C (1169 cases) contains subjects <65 years old with metabolic syndrome and group D (496 cases) is composed of subjects >64 years old with metabolic syndrome. Of the aged 1332 subjects, 595 were females (mean age, 70.6+/-4.6 years) and 737 were males (mean age, 71.3+/-5.3years), 37.2% (496/1332) had metabolic syndrome, 19.9% had DM and 21.8% had hypertension. These subjects had decreased BMI with age. Additionally, WHR peaked at an age range of 75-79 years. Of the aged subjects, also overweight, 42.8% and 33.6% were diagnosed with hypertension and DM, respectively; both ratios higher than those for non-overweight subjects (25.3% and 26.2%, respectively). Of the four groups in this study, the ratios for DM, hypertension, and WHR, HI, and LDL levels progressively increased through groups A to D. WBC count differs statistically significantly between these groups. Statistical analysis of WBC count, RBC and hemoglobin (Hb) with different parameters demonstrates significant elevation of WBC counts with the components of metabolic syndrome in aged subjects.

CONCLUSIONS

WBC count, RBC count and Hb are associated with metabolic syndrome components in younger and old adults of both genders. The incidence of metabolic syndrome marker increased after menopause onset in the female population in this study.

Application of three-dimensional body scanner: observation of prevalence of metabolic syndrome

BACKGROUND AND AIMS

This retrospective cross-sectional study correlates blood pressure, blood glucose, lipid and uric acid levels with anthropometric measurements.

METHODS

A total of 3975 visitors to the Department of Health Management were randomly selected to participate in this cross-sectional study. Whole body three-dimensional (3-D) laser scans were used to obtain anthropometric measurements. A health index (HI) was also designed based on anthropometric parameters. Subjects were defined as having metabolic syndrome when three of the following criteria were met: obesity (BMI of at least 30 kg/m(2); or a WHR of over 0.9 for males and 0.85 for females); triglyceride of at least 150 mg/dl; high-density lipoprotein (HDL)-cholesterol below 35 mg/dl for males and 39 mg/dl for females; fasting sugar levels of at least 110 mg/dl and hypertension.

RESULTS

Of 3975 subjects, 341 (8.6%) met the criteria for diabetes mellitus (DM); of these, 32.8% were diagnosed with hypertension. This proportion exceeded 18% of the subjects had normal glucose levels. Of the 3975 subjects, 658 (16.6%) met the criteria for metabolic syndrome. Proportionally, more male subjects than female subjects were diagnosed with metabolic syndrome (18.5% vs 14.7%). Of these, central obesity, elevated triglyceride and low HDL-cholesterol were the main factors in men, while fasting glucose, hypertension and central obesity were the main factors in women. This investigation found that larger proportions of subjects with impaired glucose tolerance (41.1%) and DM (64.2%) than of subjects with normal glucose subjects, suffered from metabolic syndrome (9.5%).

CONCLUSIONS

3-D body scanning is useful in correlating pertinent factors with metabolic syndrome, these factors include central obesity, hyperglycemia, dyslipidemia, hyperuricemia and hypertension.

Association of alcohol consumption with white blood cell count: a study of Japanese male office workers

OBJECTIVES

To investigate the association of alcohol consumption with white blood cell (WBC) count.

DESIGN

Cross-sectional study.

SETTING

A work site in Japan.

SUBJECTS

A total of 5218 Japanese male office workers aged 23-59 years who participated in annual health examinations.

MAIN OUTCOME MEASURES

Subjects were classified as nondrinkers, or current drinkers who averaged <12, 12-22, 23-34, 35-45, 46-68 or > or = 69 g day(-1) of ethanol. The association between alcohol consumption and WBC count was examined by smoking status.

RESULTS

After controlling for age, body mass index, systolic blood pressure, and levels of total cholesterol, high-density lipoprotein (HDL) cholesterol and fasting plasma glucose, WBC count showed a negative dose-response relation with alcohol consumption in each smoking status. The WBC count increment per category of alcohol intake (x10(9) cells L(-1)) was -0.07 [95% confidence interval (CI), -0.11 to -0.04] for never smokers, -0.11 (95% CI, -0.15 to -0.06) for ex-smokers, and -0.04 (-0.08 to -0.00) for current smokers. For current smokers, additional adjustment for cigarettes smoked per day heightened the magnitude of these associations [the respective WBC count increment (x10(9) cells L(-1)), -0.07 (95% CI, -0.11 to -0.03)]. The risk for high WBC count (fifth quintile) also showed a negative linear trend related to alcohol intake in each smoking status.

CONCLUSIONS

The WBC count was inversely associated with alcohol consumption in both nonsmokers and smokers. In view of the firm association of WBC count with the increased risk of coronary heart disease, alcohol consumption seems to have a favourable impact on the link between WBC count and the risk of cardiovascular disease.

Incidence and predictors of drug-treated diabetes in elderly French subjects. The PAQUID Epidemiological Survey

AIMS

To estimate the incidence and predictors of drug-treated diabetes in elderly subjects.

METHODS

The PAQUID epidemiological survey, a population-based study, has followed up 3,777 subjects older than 65 years since 1988. At each visit (baseline, 1, 3, 5 and 8 years), treatment regimen was used to identify new drug-treated diabetic subjects. Potential predictors of drug-treated diabetes were collected during the baseline visit (body mass index (BMI), educational level, cigarette smoking and wine consumption, physical activity, depressive symptomatology, subjective health, treatment, and hypertension) and analysed by using a multivariate backward stepwise regression Cox model with delayed entry.

RESULTS

The prevalence rate of drug-treated diabetes was 7.5% at baseline and 7.1% after 8 years' follow-up. The incidence rate of drug-treated diabetes was 3.8/1,000 person-years, 5.9/1,000 person-years in men and 2.4/1,000 person-years in women, with no significant variation according to age group. Male sex (relative risk (RR) 2.4, 95% confidence interval (CI) 1.4-4.0, P < 0.001, attributable risk (AR) 0.36), elevated BMI (for one point increase, RR 1.1, 95% CI 1.1-1.1, P < 0.001, > or = 25 vs. < 25, RR 2.1, 95% CI 1.2-3.5, AR 0.33), thiazide diuretics used alone (RR 5.9, 95% CI 1.8-19.6, P = 0.02), and poorer subjective health ('the same' vs. 'better' RR 1.8, 95% CI 1.0-3.1, P = 0.04; 'worse' vs. 'better' RR 2.3, 95% CI 0.9-5.7, P = 0.06) were independent predictors of drug-treated diabetes in this population.

CONCLUSIONS

In older French individuals, men seem to be particularly exposed to drug-treated diabetes although being overweight was found to be a strong predictor as in younger populations.

Frequency and significance of the A-->G (-3826) polymorphism in the promoter of the gene for uncoupling protein-1 with regard to metabolic parameters and adipocyte transcription factor binding in a large population-based Caucasian cohort

BACKGROUND

The recently described A-->G (-3826) point mutation within the distal region of the UCP-1 promoter is possibly involved in the development of obesity, diabetes and related metabolic disorders. It was the aim of this study to examine the allelic frequency and the prevalence of the three UCP-1 genotypes in a broad caucasian cohort and to investigate the significance of this polymorphism for obesity and diabetes.

METHODS

1020 subjects were randomly chosen from 6450 participants in the Diabetomobile Study. The UCP-1 genotype was determined by genomic PCR and Bcl-I-RFLP analysis in 1020 subjects and tested for association with a variety of metabolic parameters. In addition, the influence of this mutation on adipocyte nuclear factor binding was investigated by electrophoretic mobility shift assays (EMSA).

RESULTS

The genotype frequencies in 1020 subjects were: AA genotype, 57.0%; AG genotype, 35.4%; GG genotype, 7.6%; with allelic frequencies of 0.75 for allele A and 0.25 for allele G. No significant differences between the genotypes and age, gender, BMI, leptin, glucose, fasting insulin, C-peptide, HbA1c, diabetes manifestation, total cholesterol, and HDL cholesterol were found. Analysis of the Trp64Arg polymorphism of the beta3-adrenergic receptor in a subgroup of 343 subjects revealed no additive effect to the UCP-1 polymorphism. An yet unknown adipocyte-specific factor of nuclear extracts from 3T3-L1 adipocytes during differentiation is able to bind specifically to the distal UCP-1 promoter region and this binding ability can not be abolished by the mutation.

CONCLUSIONS

We determined the genotype and allelic frequency of the UCP-1 promoter polymorphism in the largest known population-based study. The results from genotyping demonstrate clearly that this polymorphism does not play a major role in the pathogenesis obesity and diabetes. A yet unknown adipocyte derived and differentiation-dependent regulated transcription factor is able to bind to the distal UCP-1 promoter surrounding -3826 bp. This binding is not affected by presence of the mutation.