A Cutoff for Age at Menarche Predicting Metabolic Syndrome in Egyptian Overweight/Obese Premenopausal Women

Previous studies showed that early age at menarche is associated with increased risk of metabolic syndrome. However, the definition of early menarche at these studies was based on background data in the communities at which these studies was carried on. The aim of this work is to determine a cutoff for age at menarche discriminating presence or absence of metabolic syndrome in overweight/obese premenopausal women. This study included 204 overweight/obese women. Metabolic syndrome was defined according to NCEP-ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria. Of a total 204 participants, 82 (40.2%) had metabolic syndrome. By using receiver operating characteristic analysis, age at menarche ≤12.25 year discriminated individuals with from those without metabolic syndrome. The area under the curve was 0.76 (95% confidence interval, 0.70 to 0.83). Sensitivity, specificity, negative predictive value, and positive predictive value were 82%, 70%, 85%, and 64%, respectively. Age at menarche ≤12.25 years predicts the presence of metabolic syndrome in overweight/obese women.

Evaluation of insulin resistance and low grade inflammation in Egyptian women with subclinical hypothyroidism

Subclinical hypothyroidism [SCH] is a prevalent condition among adult population. SCH is characterized by slightly elevated serum TSH levels above the reference range and normal serum free T4 concentrations. The present study aimed to assess the association of hs-CRP [index of low grade inflammation] and insulin resistance index [HOMA-IR] in women with SCH. To achieve this goal a 26 women with SCH were enrolled in this work [age= 40.7 +/- 4.6 years] with TSH > 4.2 micro IU/ml and normal FT4, beside 20 woman. [age= 40.1 +/- 4.6SD years] as a control group. Participants with clinically apparent inflammatory thyroid diseases, any medications known to affect TSH, hs-CRP, lipid levels and insulin resistance, thyroid hormone medication up to 3 months before enrollment, pregnancy, and pituitary/hypothalamic disorders were excluded. BMI, waist circumference, FT3, FT4, hs-CRP, fasting insulin, glucose, total, HDL, LDL cholesterol, triglyceride, total cholesterol/HDL-c, LDL-c/ HDL-c ratios, HOMA-beta and HOMA-IR were determined in all participants. The mean serum levels of hs -CRP, TSH, fasting insulin, prolactin levels of subjects with SCH was higher than those of the control group [All p values = <0.05]. The SCH group had statistically non significant higher HOMA- IR values [2.1 +/- 0.4] than those of control subjects [1.9 +/- 0.3] [p=0.06]. However the mean values of serum fasting glucose, HOMA-J3, FT3, and FT4, were not differ in the 2 groups [all p values > 0.05]. There were positive correlation between insulin and hs-CRP [r=0.5, p=0.009], fasting insulin levels and TSH levels [r=043, p=0.03]. Female patients with SCH have higher serum hs-CRP level [low grade inflammation] which was associated with fasting hyperinsulinemia before obvious insulin resistance in patients with SCH. Therefore screening and early treatment for SCH may be an urge due to its adverse impacts on atherogenic indices

Carotid artery intima-media thickness and endothelial function in patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease [NAFLD] is an increasingly recognized cause of liver related morbidity and mortality. Recently, there is increasing evidence of its association with atherosclerotic risk factors and potential cardiovascular risk. The aim of the present study was to evaluate carotid artery intima-media thickness [IMT] and endotheliol function as markers of preclinical atherosclerosis in patients with NAFLD. Methods: The present study included 24 patients with ultrasound diagnosed NAFLD [14 men and 10 women, mean age 47.4 +/- 6.7 years] and 20 age and sex matched control subjects. Patients and control groups were evaluated for metabolic syndrome [Met S] according to Adult Treatment Panel III, insulin resistance index [HOMA-IR], high sensitivity C-reactive protein [Hs-CRP] carotid artery IMT and brachial artery flow mediated dilatation in response to ischemia [FMD] and nitroglycerine induced dilatation [NID]. Visceral obesity, hypertriglyceridemia were more frequent [P=0.03 and 0.01 respectively] with 3 fold increase in the frequency of Met S [33% vs 10%] in NAFLD patients as compared to controls. NAFLD group had increased mean IMT [0.713 +/- 0.181 vs 0.593+0.125, P=0.017], increased plaque frequency [37.5% vs 10%, P=0.03], and lower FMD and NID [5.67 +/- 2.07% us 7.78 +/- 2.42%, P=0.003 and 8.42 +/- 2.71% us 10.31 +/- 2.53%, P=0.022, respectively] as compared to control group. In NAFLD group, IMT correlated significantly with BMI, TG, HOMA-IR [P<0.0001], waist circumference, SBP and Hs-CRP [P=0.002, 0038 and 0.009 respectively], percent FMD correlated significantly with BMI, waist circumference, HOMA-IR, TG and Hs-CRP [P=0.011, 0.003, 0.01, 0.001 and 0.02 respectively]. NAFLD is associated with increased carotid IMF and endothelial dysfunction which are related to the frequent metabolic syndrome features and point to accelerated atherosclerosis. Screening of NAFLD patients with metabolic syndrome features together with the use of non-invasive measures for assessment of preclinical atherosclerosis, could help in early risk assessment and guide for proper life style and therapeutic measures aiming at vascular risk reduction

Brothers of women with polycystic ovary syndrome: a new group with high risk for type 2 diabetes mellitus and cardiovascular disease

Polycystic ovary syndrome [PCOS] is common endocrinal disorder which is highly inherited and characterized by many metabolic abnormalities. We hypothesized that male relatives of PCOS women would also have metabolic abnormalities. Thus, our aim was to assess insulin sensitivity and metabolic parameters in brothers of women with PCOS and male control individuals. 30 brothers of women with PCOS and 20 male healthy control subjects were included in the study. Brothers and control were subjected to complete medical evaluation with stress on anthropometric measurements, fasting insulin, homeostasis assessment model [HOMA-IR], lipids, plasminogen activator inhibitor-1 [PAI-1], C-reactive protein [CRP] and androgens. Brothers and control individuals were similar as regard to age, MBI, WHR and blood pressure. However, brothers were insulin resistant and had dyslipidemia and dyscoagulability [HOMA-IR, P=0.043, TC P=0.001, LDL-C P=0.002, HDL-C P=0.03, TG P=0.048, PAI-1 P=0.002, CRP P=0.046]. Also HOMA-IR, was correlated significantly with BMI p<0.001, WHR P<0.001, PAI-1 P<0.001, CRP P<0.01, TG, P<0.001, LDL-C P=0.02, HDL-C P=0.019]. Brothers of women with PCOS have a metabolic phenotype consisting of dyslipidemia, insulin resistance, dysmgulability and carry an increased risk of cardiovascular disease [CVD] and type 2 diabetes mellitus [type 2 DM]. Given the high prevalence of PCOS, brothers may represent an important new risk factor for CVD in men and should be considered a well identified group for primary preventive measures

Pulse pressure and inflammatory markers in subjects with type 1 diabetes mellitus

Type 1 diabetes is associated with excessive cardiovascular risk and earlier age-related Increase in pulse pressure [PP]. Inflammation and PP are predictors of cardiovascular disease. However few data suggested that PP may stimulate inflammation. Therefore. the present study aimed to determine the levels of some inflammatory markers [tumour necrosis factor alpha. interleukln-6 and C-reactive protein] and to study the relation between PP and these markers in normotensive subjects with type I diabetes mellitus with and without microvascular complications. The present study included 50 normotensive subjects [<130/85 mmHg] with type I diabetes meliltus [T1DM], 24 of them with microvascular complications [mean age 39.6 +/- 5.4 years] and 26 of them without microvascular complications [mean age 29.7 +/- 6.9 years] 20 healthy subjects [mean age 33.3 +/- 8.5 years] were selected as a control group. Recorded data Included age, sex, duration of diabetes, body mass index [DMI]. waist-to-hip ratio [WHR], systolic blood pressure [SBP], diastolic blood pressure [DBP]. pulse pressure [PP]. mean arterial blood pressure [MAP], microvascular complications, lipid profile. HbAlc. estimated glucose disposal rate [eGDR] and serum concentration of tumour necrosis factor-alpha [TNT-alpha]. interleukin-6 [IL-6] and C-reactive protein [CRP]. Compared with control subjects, diabetic patients with and without microvascular complications had higher PP [47 +/- 3 and 41 +/- 4 vs 37 +/- 4. P<0.001 and P<0.01 respectively], CRP [6.04 +/- 0.6 and 4.11 +/- 0.64 vs 2.59 +/- 0.57, P<0.001. both], 1L6 [31.66 +/- 3.3 and 21.38 +/- 36.2 vs 11.5 +/- 2.81, P<0.001 both], and TNT-alpha [66.45 +/- 12.66 and 37.26 +/- 8.17 vs 32.05 +/- 6.3, P<0.001 and P<0.05 respectively]. PP CRP. IL-6 and TNF-alpha were elevated [P<0.001 all] in diabetic patients with versus those without microvascular complications. CRP. IL-6 and TNF-alpha levels were higher in diabetic patients with macroalbuminuria compared to those with microalbuminuria [P<0.05 and P=0.012 and P<0.001 respectively]. PP in diabetic patients showed significant correlation with micro and macrovascular complications [P<0.0001]. CRP. IL-6 and TNF-alpha in diabetic patients had significant correlation with PP [r=0.722, P<0.0001 and r=0.770, P<0.0001 and r=0.775. P<0.0001 respectively] and diabetic micro and macrovascular complications [P<0.0001]. In normotensive subjects with type I diabetes mellitus. Inflammatory markers and PP are increased and have significant relation with each other and with diabetic microvascular complications. So. lowering of both PP and Inflammation might be helpful to optimize therapeutic management of vascular disease in type diabetes