Use of plasma triglyceride/high-density lipoprotein cholesterol ratio to identify increased cardio-metabolic risk in young, healthy South Asians.

Background & objectives: Prevalence of insulin resistance and associated dyslipidaemia [high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations] are increased in South Asian individuals; likely contributing to their increased risk of type-2 diabetes and cardiovascular disease. The plasma concentration ratio of TG/HDL-C has been proposed as a simple way to identify apparently healthy individuals at high cardio-metabolic risk. This study was carried out to compare the cardio-metabolic risk profiles of high-risk South Asian individuals identified by an elevated TG/HDL-C ratio versus those with a diagnosis of the metabolic syndrome. Methods: Body mass index, waist circumference, blood pressure, and fasting plasma glucose, insulin, TG, and HDL-C concentrations were determined in apparently healthy men (n=498) and women (n=526). The cardio-metabolic risk profile of “high risk” individuals identified by TG/HDL-C ratios in men (≥ 3.5) and women (≥2.5) was compared to those identified by a diagnosis of the metabolic syndrome. Results: More concentrations of all cardio-metabolic risk factors were significantly higher in “high risk” groups, identified by either the TG/HDL-C ratio or a diagnosis of the metabolic syndrome. TG, HDL-C, and insulin concentrations were not significantly different in “high risk” groups identified by either criterion, whereas plasma glucose and blood pressure were higher in those with the metabolic syndrome. Interpretation & conclusions: Apparently healthy South Asian individuals at high cardio-metabolic risk can be identified using either the TG/HDL-C ratio or the metabolic syndrome criteria. The TG/HDL-C ratio may be used as a simple marker to identify such individuals.

Serum resistin as a biomarker for hepatic state in HCV infected patients and its relation to insulin resistance

Patients with chronic liver disease display disturbances of glucose metabolism which is more prevalent among patients with chronic HCV compared with those with other liver diseases and the general population, irrespective of whether cirrhosis is resent. Insulin resistance, a "prediabetic" abnormality of blood sugar, is a specific feature of chronic hepatitis C virus [HCV] infection. To evaluate the clinical utility of the adipokine hormone resistin a potential mediator in inflammatory processes as a biomarker of disease progression in HCV infected patients and to assess if it is involved in the pathogenesis of insulin resistance. The study included 60 HCV infected patients and 20 healthy subjects as control. All cases were recruited from Kasr El Ani Hospital. They were classified into 3 groups; group [I]: Included 20 cases of HCV infected patients with no liver cirrhosis; group [II]: Included 40 cases of HCV infected patients with liver cirrhosis, it was subdivided into three subgroups according to Child-Pugh classification which were [IIa]10 cases, [IIb] 15 cases and [IIc] 15 cases and group [III]: Control group included 20 healthy subjects who were matched with the studied patients as regard age, sex and body mass index. Abdominal ultrasonography, upper endoscopy [for patient groups only], liver function, complete blood picture, erythrocytes sedimentation rate [ESR], C-reactive protein [CRP], blood sugar, fasting insulin, fasting C-peptide with calculation of insulin sensitivity [IS] by the quantitative insulin sensitivity check index [QUICKI] and serum resistin levels were done for all participants. Serum resistin level showed statistically highly significant elevation in HCV infected patients compared with the matched control group [p<0.001] and also its level showed statistically significant differences in subgroups of group [II] being higher in patients presented with complication of liver cell failure [p<0.01]. Its serum level was inversely correlated with the hepatic synthetic function including albumin [r=-0.476, p<0.001] and prothrombin concentration [r=-0.346, p<0.001]. Also, a positive correlations between resistin and biomarkers of inflammation including CRP [r=0.305, p<0.004] and TLC [r=0.268, p<0.01] and insulin resistance parameters [C-peptide r=0.285, p<0.01] were detected, while resistin was inversely correlated with insulin sensitivity [QUICKI] [r=-0.289, p<0.05]. This study demonstrates that serum resistin level is elevated in patients with HCV related chronic liver disease and might be used as a biomarker for the clinical progression of the disease. The correlation of resistin to the insulin resistance [IR] present in such patients, may suggest its possible role in the pathogenesis of insulin resistance