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Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a multifactorial disorder with combination of environmental, genetic and metabolic factors that play role in the progression of disease. This study is aimed to explore the familial clustering of NAFLD among the family members of NASH cirrhotic patients and the association of insulin resistance, metabolic syndrome and genetic polymorphism with the familial clustering. Methods: This cross-sectional observational study included 50 NASH cirrhosis patient and 81 1st degree relatives. Family members were screened for fatty liver by ultrasonogram. Insulin resistance, metabolic syndrome, PNPLA3 and staging of liver stiffness by fibroscan were done. Results: Among 81 family members 47 (58.02%) were found having fatty liver. Of these 14(17.28%) had significant fibrosis. PNPLA3 polymorphism was higher (80.85%) in fatty liver group than (55.9%) without fatty liver groups. Sons (57.89%) and daughters (51.6%) were affected by fatty liver equally. Multivariate logistic regression analysis revealed that a subject with TG>150 mg/dl had 6.159 times increase in odds having NAFLD. A subject with PNPLA3 polymorphism had 3.33 times increase in odds having NAFLD. A subject with HOMA-IR >1.6 had 4.375 times increase in odds having NAFLD. Conclusion: This study indicates that there is a strong familial clustering of NAFLD along with significant fibrosis among the family members of NASH cirrhosis patients. This findings warrants screening for NAFLD among the family members of NASH cirrhosis patients especially with PNPLA3 polymorphism.
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Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Some studies have characterized different aspects of women presenting with PCOS. In this study we characterise the association of insulin resistance (IR) in patients with PCOS in the southern Indian state of Andhra Pradesh.Methods: A total of 50 women diagnosed to have PCOS according to Rotterdam criteria were studied. IR was estimated using Homeostatic model assessment - insulin resistance (HOMA-IR) and clinical characteristics were recorded.Results: The prevalence of IR among the study population was 36%. All PCOS patients with IR were overweight or obese, and had impaired glycaemic status, 75% of PCOS patients with IR also had features of hirsutism.Conclusions: Considering the prevalence of IR, obesity and impaired fasting glucose in women with PCOS, early institution of treatment by lifestyle changes or medication would lead to improvement in reproductive and metabolic abnormalities.
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The aim of this cross-sectional study was to evaluate the association between vasomotor symptoms (VMS) and insulin resistance, which can be postulated by the homeostatic model assessment (HOMA) index. This study involved 1,547 Korean postmenopausal women (age, 45 to 65 years) attending a routine health check-up at a single institution in Korea from January 2010 to December 2012. A menopause rating scale questionnaire was used to assess the severity of VMS. The mean age of participants was 55.22+/-4.8 years and 885 (57.2%) reported VMS in some degree. The mean HOMA index was 1.79+/-0.96, and the HOMA index increased with an increase in severity of VMS (none, mild, moderate and severe) in logistic regression analysis (beta=0.068, t=2.665, P =0.008). Insulin resistance needs to be considered to understand the linkage between VMS and cardiometabolic disorders.
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Female , Humans , Cross-Sectional Studies , Insulin Resistance , Korea , Logistic Models , MenopauseABSTRACT
Background: Liver is the major site for carbohydrate, protein and lipid metabolism. In liver cirrhosis, derangements in metabolic functions can happen. Liver cirrhosis can lead to insulin resistance then impaired glucose tolerance and finally diabetes. The occurrence of insulin resistance in cirrhosis has definite clinical implications like rapid progression to fibrosis and increased risk of gastrointestinal haemorrhage and hepatocellular carcinoma. Objectives: This study was done to find the prevalence of insulin resistance in patients with cirrhosis in Government Royapettah Hospital due to varied etiology. Materials and methods: It was a cross sectional study done on 50 subjects in Government Royapettah Hospital. Patients were selected according to the inclusion criteria. A detailed history was taken, and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Insulin resistance was assessed using three indices: HOMA1 IR, HOMA2 IR calculator and TyG index. Results: The mean age of the population was 46.18± 9.78 years. 94% of patients were males and 6% were females. Among the fifty subjects included, 34% had insulin resistance according to HOMA 1 IR (p 0.024) and 28% with HOMA2 IR (p 0.002). Insulin resistance using both HOMA 1 and 2 was significantly increased in Child Turcott Pugh C (p <0.001 for both). Insulin resistance was not demonstrated in any of subjects using TyG index. There was positive correlation between insulin resistance and fasting glucose and insulin. S Kalaichelvi, Kiruthika Somasundram. Prevalence of insulin resistance among patients with cirrhosis of liver in Government Royapettah Hospital, Chennai. IAIM, 2016; 3(7): 21-27. Page 22 Conclusion: Insulin resistance is demonstrated in liver cirrhosis which is increased with advancing disease. It can be concluded that regular monitoring of glycemic status is mandatory in these patients who would have definite bearing upon treatment strategy.
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Aim: to determine cut off points for The Homeostatic Model Assessment Index 1 and 2 (HOMA-1 and HOMA-2) for identifying insulin resistance and metabolic syndrome among a Cuban-American population. Study Design: Cross sectional. Place and Duration of Study: Florida International University, Robert Stempel School of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, FL from July 2010 to December 2011. Methodology: Subjects without diabetes residing in South Florida were enrolled (N=146, aged 37 to 83 years). The HOMA1-IR and HOMA2-IR 90th percentile in the healthy group (n=75) was used as the cut-off point for insulin resistance. A ROC curve was constructed to determine the cut-off point for metabolic syndrome. Results: HOMA1-IR was associated with BMI, central obesity, and triglycerides (P<0.05). HOMA2-IR was associated with BMI, central obesity, total cholesterol, HDL-cholesterol and LDL-cholesterol (P<0.05). The cut-off points for insulin resistance for HOMA-1 and HOMA-2 were >3.95 and >2.20 and for metabolic syndrome were >2.98 (63.4% sensitivity and 73.3% specificity) and >1.55 (60.6% sensitivity and 66.7% specificity), respectively. Conclusion: HOMA cut-off points may be used as a screening tool to identify insulin resistance and metabolic syndrome among Cuban-Americans living in South Florida.
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Background: Polycystic ovary syndrome (PCOS) is a complex, heterogeneous disorder of uncertain etiology, characterized by irregular menses, chronic anovulation, infertility, hyperandrogenism, and insulin resistance. Aims: To determine insulin resistance in infertile Sudanese patients with PCOS and evaluate its significant relation ship to infertility. Method: A hospital based transversal study was conducted at the Minimal Access Gynecology Surgery (MAGS) unit at Omdurman Maternity Hospital from June 2010 to August 2012 .61 infertile patients with PCOS using Rotterdam 2003 definition and who did not conceive after diet, lifestyle and clomiphene as study group and 61 normoovulatory infertile patients with normal ovaries served as a control group at laparoscopy, their serum were sent to the laboratory for estimation of fasting glucose and insulin levels, and then calculation of homeostatic model assessment (HOMA) and p value. Results: 44(73%) out of the 61infertile patients with PCOS were young, obese with BMI>30, hirsutism was seen in 45 (73.5%) and acne was observed in 42 (70%). Fasting blood glucose (FBG) of 100-125 mg/dl, was encountered in 18(30%) and 3 were diabetic (FBG >125). Fasting insulin level was not significantly elevated in the study group, while Insulin resistance calculated using HOMA. Mean HOMA in the obese PCOS group was significantly higher than in the obese normal ovary group (2.68 ± 2.19 versus 1.26 ± 1.05, P = 0.005). Conclusion: The majority of the study population was young, obese and had insulin resistance This finding may have important implications in the short term regarding reproductive performance, and in the long term regarding type 2 diabetes and cardiovascular complications
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To study the effect and mode of action of water extract (DVW) and polar fraction of ethanol extract (DVE-4) of D. viscosa in high-fructose diet induced insulin resistance in male Wistar rats. D. viscosa’s effects were evaluated on a battery of targets involved in glucose homeostasis (in vitro studies). Rats were rendered insulin resistant by feeding 66% (w/w) fructose and 1.1% (v/w) coconut oil mixed with normal pellet diet (NPD) for six weeks. DVW and DVE4 at different doses were administered simultaneously. At the end of the study, blood glucose, oral glucose tolerance test, lipid profile and insulin were estimated and homeostatic model assessment (HOMA) levels were calculated. In addition, enzymatic and non-enzymatic liver antioxidant levels were also estimated. Quantification of biomarker quercetin was done using HPLC. Fructose diet with DVW, DVE-4 significantly reduced blood glucose, serum insulin, HOMA, lipid profiles and significantly improved glucose tolerance and HDL-c levels. In addition, these extract and fraction also decreased oxidative stress by improving endogenous antioxidants. In different bioassays, DVW and DVE-4 inhibited protein tyrosine phosphatase-1B with IC50 65.8 and 54.9 g/ml respectively and showed partial inhibition of dipeptidyl peptidase-IV. Moreover, DVW and DVE-4, at 10 mg/ml showed 60 and 54.2% binding to peroxisome proliferator-activated receptor-g. Further, 2.1% (w/w) of quercetin was quantified in bioactive-DVE-4 using HPLC method. The results provide pharmacological evidence of D. viscosa in treatment of prediabetic conditions and these effects may be mediated by interacting with multiple targets operating in diabetes mellitus.
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O diagnóstico de síndrome metabólica (SM) segundo o National Cholesterol Education Program Adult Treatment Panel III não reflete necessariamente a presença de resistência à insulina (RI), um potencial alvo terapêutico para prevenção de diabetes tipo 2 e doenças cardiovasculares. Em estudo de corte transversal, assentado em dados anteriores de prevalência, avaliamos o comportamento do HOMA-RI, um parâmetro de RI bem difundido, frente à SM e anormalidades associadas. HOMA-RI foi maior nos indivíduos com SM (2,8 ± 1,6 vs. 1,8 ± 1,4) (p < 0,001) e mostrou excelente correlação com insulinemia de jejum (rS = 0,961). HOMA-RI > 2,5 aliou bons níveis de especificidade e sensibilidade para a associação de SM e RI. Diferente de aumento da glicemia, obesidade abdominal e elevação da trigliceridemia, componentes da SM mais bem relacionados com RI, a elevação da pressão arterial e a redução do HDL-c não mostraram associação com HOMA-RI > 2,5. A demonstração de que alguns fenótipos de SM ou anormalidades associadas foram mais preditivos de RI pode apontar para a possibilidade de uso do índice como um indicador de RI associada à SM.
The diagnosis of the metabolic syndrome (MS) according to the National Cholesterol Education Program Adult Treatment Panel III does not reflect necessarily the presence of insulin resistance (IR), a potential therapeutical target for type 2 diabetes and cardiovascular disease prevention. Based on previous prevalence data, a cross-sectional study was conducted to determine the HOMA-IR relationship to the MS and some associated abnormalities. HOMA-IR > was higher in individuals with the MS (2.8 ± 1.6 vs. 1.8 ± 1.4) (p < 0.001). HOMA-IR > or = 2.5 allied good specificity and sensitivity levels for the association of MS and IR. Hyperglycemia, hypertrigliceridemia, and abdominal obesity, the MS components best related to IR, were statistically associated with HOMA-IR > 2.5, but not hypertension neither low HDL-c. The demonstration that some of MS phenotypes or associated abnormalities were more predictive for IR could point out to the possibility of the use of the index as a marker of the presence of IR associated to MS.