Metabolic syndrome components correlation with colorectal neoplasms: A systematic review and a meta-analysis

Background : Patients with metabolic syndrome (MetS) have a higher risk of developing colorectal neoplasms (CRN) including colorectal adenoma (CRA) and colorectal cancer (CRC). Nonetheless, the role and implication of each component of the syndrome, i.e. (hyperglycemia, hypertension, dyslipidemia, and visceral obesity) are not well ascertained. Aims: We conducted a systematic review and a meta-analysis in order to assess the association between MetS components and CRN. Methods and Material: A systematic literature search using the PubMed database was performed with the objective of identifying relevant English studies. Effect estimates were measured. Heterogeneity, subgroup, sensitivity analyses, and publication bias analyses were performed. Results: Thirty-one studies met our inclusion criteria. Generally, subjects with hyperglycemia (RR = 1.33; 95% CI 1.14-1.54), high waist circumference (RR = 1.30; 95% CI 1.19-1.42), high triglycerides (RR = 1.30; 95% CI 1.13-1.49), and hypertension (RR = 1.26; 95% CI 1.17-1.36) showed a stronger positive significant association with CRA formation risk. A similar pattern was found between high fasting blood glucose (RR = 1.35; 95% CI 1.23-1.47) and high blood pressure (RR = 1.28; 95% CI 1.20-1.37) with CRC incidence. A moderate association was found between hypertriglyceridemia and visceral obesity with CRC risk. Conversely, no significant association was found between low high-density lipoprotein-cholesterol (HDL-C) with both outcomes. Conclusions: Our results indicate that hyperglycemia, hypertension, visceral obesity, and hypertriglyceridemia increases CRA and CRC risk. Low HDL-C has no significant effect on those outcomes

Can Metabolic Factors be Used Prognostically for Short-Term Mortality in HIV-Infected Patients?

Background: Metabolic abnormalities are common throughout the course of human immunodeficiency virus (HIV) infection and may occur either due to HIV infection or as a result of side effects of antiretroviral therapy. It has been established that dyslipidemia and dysglycemia associated with HIV disease reduce the long-term survival of the patients; but their role for predicting prognosis of short-term mortality in HIV patients is unknown. Aim: To study dyslipidemia and dysglycemia as a prognostic indicator for short-term mortality (3 months) in HIV patients. Subjects and Methods: An observational; prospective study was conducted at a tertiary care center over a period of 6 months. Consecutive HIV-positive patients hospitalized (both; HIV status known prior to hospitalization and the diagnosis made for the first time at admission) in medical wards from March to May 2010 were studied. All patients had their random blood sugars; fasting blood sugars (if possible); fasting lipid profile; and cluster of differentiation 4 (CD4) counts tested at the time of enrollment. The patients were followed for a period of 3 months; at the end of which they were categorized as survivors and non-survivors; and the demographic; clinical; and investigational parameters were compared between the above groups. Data was analyzed by applying Mann-Whitney U test; two sample t-test; Fisher-Exact test; and stepwise logistic regression analysis of significance; using the computer-based program; Stata; version 11.1. Results: A total of 82 patients were enrolled for the study of which 64 (78.05) were males and 18 (21.95) were females; with a mean (SD) age of 34.00 (7.0) years. The mean CD4 count was 206.23 (129.5) cells/mm 3 . The overall mortality within 3 months was 20.7 (17/82). Mycobacterium tuberculosis as opportunistic infection was found in 42 patients; out of which 13 expired (P

Can Metabolic Factors be Used Prognostically for Short-term Mortality in HIV-infected Patients?

Metabolic abnormalities are common throughout the course of human immunodeficiency virus (HIV) infection and may occur either due to HIV infection or as a result of side effects of antiretroviral therapy. It has been established that dyslipidemia and dysglycemia associated with HIV disease reduce the long-term survival of the patients; but their role for predicting prognosis of short-term mortality in HIV patients is unknown. Aim: To study dyslipidemia and dysglycemia as a prognostic indicator for short-term mortality (3 months) in HIV patients. Subjects and Methods: An observational; prospective study was conducted at a tertiary care center over a period of 6 months. Consecutive HIV-positive patients hospitalized (both; HIV status known prior to hospitalization and the diagnosis made for the first time at admission) in medical wards from March to May 2010 were studied. All patients had their random blood sugars; fasting blood sugars (if possible); fasting lipid profile; and cluster of differentiation 4 (CD4) counts tested at the time of enrollment. The patients were followed for a period of 3 months; at the end of which they were categorized as survivors and non-survivors; and the demographic; clinical; and investigational parameters were compared between the above groups. Data was analyzed by applying Mann-Whitney U test; two sample t-test; Fisher-Exact test; and stepwise logistic regression analysis of significance; using the computer-based program; Stata; version 11.1. Results: A total of 82 patients were enrolled for the study of which 64 (78.05) were males and 18 (21.95) were females; with a mean (SD) age of 34.00 (7.0) years. The mean CD4 count was 206.23 (129.5) cells/mm 3 . The overall mortality within 3 months was 20.7(17/82). Mycobacterium tuberculosis as opportunistic infection was found in 42 patients; out of which 13 expired (P

Hypertriglyceridaemia: Aetiology; Complications and Management

The bulk of plasma triglycerides are carried by chylomicrons in the fed and very low-density lipoproteins in the fasted state. These triglyceride-rich lipoproteins are metabolised to remnant lipoproteins by lipoprotein lipase (LPL). Hypertriglyceridaemia results if triglyceride-rich lipoproteins accumulate either due to defective clearance; overproduction or a combination of both mechanisms. Genetic and environmental factors interact in the genesis of hypertriglyceridaemia but occasionally a single factor may be dominant. At a molecular level the most common cause of severe primary hypertriglyceridaemia is loss of function mutations in both alleles of LPL. The most common environmental contributors include diabetes; diet; alcohol and medications (including oestrogen; steroids; retinoids and protease inhibitors). Severe hypertriglyceridaemia can trigger acute pancreatitis while mild to moderate hypertriglyceridaemia is an independent cardiovascular risk factor. Treatment strategies are determined by the severity and aetiology of hypertriglyceridaemia as well as the patient's cardiovascular risk profile. General strategies include lifestyle modifications with restriction of dietary fat intake; cessation of alcohol intake and increased exercise. Contributing metabolic disorders should be controlled and aggravating medications withdrawn or reduced where possible. Moderate hypertriglyceridaemia may be treated with high doses of omega-3 fatty acids (4 g/day); fibrates; niacin or statins. Fibrates are the agents of choice in severe hypertriglyceridaemia

Insulin Resistance: Causes and Metabolic Implications

Insulin is an anabolic hormone that plays key roles in glucose metabolism. Insulin resistance is a decreased biological response to normal concentration of circulating insulin. In insulin resistance; normal amounts of insulin are inadequate to produce a normal insulin response from fat; muscle and liver cells. Insulin resistance in fat cells results in hydrolysis of stored triglycerides; which elevates free fatty acids in the blood plasma. In muscles; it reduces glucose uptake; whereas in the liver; it reduces glucose storage with both effects serving to elevate blood glucose. High plasma levels of Insulin and glucose due to Insulin resistance often lead to metabolic syndrome and type 2 diabetes mellitus. The cause of the vast majority of cases of insulin resistance remains unknown. However; it is claimed that insulin resistance might be caused by a high carbohydrate diet. Studies have shown that glucosamine (often prescribed for joint problems) may cause Insulin resistance. It is also reported that insulin resistance occurrence in a population increased as sugar consumption and addition of high fructose corn syrup to diets increased. Physical inactivity and obesity have been implicated as factors; which aggravate insulin resistance. The presumption that a defect in specific gene may cause insulin resistance is still under investigation

Diabete et hyperlidemies en Cote d'Ivoire

Notre travail est une etude transversale menee sur une periode de douze ans (1986-1997) et relatif a l'association Diabete et hyperlipidemies en Cote d'ivoire. Il a concerne 1264 diabetiques regulierement suivis a la consultation d'Endocrinologie et Maladies Metaboliques du CHU de Treichville. Les resultats sont les suivants. Sur le plan epidemiologique : prevalence de l'association diabetehyperlydemies : 33 pour cent avec 38;1 pour cent d'hypercholesterolemie pure; 41 pour cent d'hypertriglyceridemie et 20;9 pour cent d'hyperlipidemie mixte; la tranche d'age 45-60 ans est la plus atteinte (61;6 pour cent); la morbidite est sensiblement la meme chez l'homme (51;2 pour cent) et la femme (38;8 pour cent); les patients de niveau socio-economique bas predominent (53 pour cent); le groupe ethno-culturel Kwa (Akan) est apparemment le plus touche; sans doute en raison de sa predominance dans la population Ivoirienne. Sur le plan bioclinique : Le DNID predomine avec 83;7 pour cent et l'hyperglycemie chronique est en correlation avec l'hyperlipidemie chez le diabetique; -baisse du HDL-cholesterol dans 26 pour cent des cas et elevation du LDL-cholesterol dans 38;2 pour cent des cas. Sur le plan evolutif : Les complications infectieuses urinaires ont une correlation avec le statuts lipidique et le diabetique hyperlipidemique semble faire plus de coronaropathie que le non hyperlipidemique. Repartition des facteurs de risque cardiovasculaire associes : 68;6 pour cent d'UTA; 43;2 pour cent d'obesite et 18 pour cent d'hyperuricemie. Sur le plan therapeutique : Le regime hypolipidique predomine (75;8 pour cent). Il est d'autant plus favorable qu'il s'agit d'un cas d'hypercholesterolemie pure (66;7 pour cent); la qualite de l'observance du traitement est d'autant plus mauvaise qu'il s'agit d'un patient de niveau socio-economique bas; en raison de son faible pouvoir d'achat (76;8 pour cent). L'association Diabete et hyperlipidemies; relativement frequente; vient alourdir les mesures de prise en charge deja difficiles et couteuses des diabetiques en cote d'Ivoire

Etude de la prevalence des troubles lipidiques au sein d'une population saine a Cotonou (Benin)

Sur une population rigoureusement selectionnee; indemne de tout facteur de risque en rapport avec les parametres du bilan lipidique de routine pratique a Cotonou; les auteurs ont determine la prevalence des dysfonctionnements du metabolisme des lipides. Il est important de parfaire ce travail par le dosage; aujourd'hui possible localement; des apolipoproteines et des lipoparticules qui sont des marqueurs plus sensibles et plus fiables de l'atherosclerose (7; 10; 13). Seule une etude multicentrique; bien conduite; peut permettre de faire le point de la question en Afrique afin de determiner le risque encouru par les populations et de moduler la conduite a tenir devant les depassements anormaux des lipides a potentialite atherogene chez l'Africain