A case report of tumor-induced osteomalacia: eight year followed-up.

Tumor-induced osteomalacia (TIO) is a rare but potentially curable disease. It is caused by excessive renal clearance ofphosphate induced by a substance secreted from the tumor Here, the authors report a Thai patient who presented with multiple pathologic fractures, low serum phosphorus, and low tubular maximum reabsorption of phosphorus/glomerular filtration rate (TmPO4/GFR). The clinical, biochemical and bone abnormalities improved 6 months after the surgery. Two years follow-up showed no recurrence of the disease. Physicians should be aware of this condition when encountering with adult onset osteomalacia.

Comparative study of direct-measured and calculated LDL in clinical use.

OBJECTIVE: Compare DLDL-C and CLDL-C obtained during regular service in hospital. MATERIAL AND METHOD: The study at Bangkok Hospital included 9,285 lipid profiles of different individuals that contained total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), and directly-measured (by homogeneous method) LDL cholesterol (DLDL-C). The population has mean age 45.92 +/- 12.43 years, 48% were male. LDL-C values were also calculated by Friedewald equation (CLDL-C). However, it was known to have limitation when TG > 400 mg/dL. RESULTS: The DLDL-C is 13.4 +/- 8.8% higher than CLDL-C. The authors could obtain CLDL-C closer to DLDL-C in wider TG range, including other explanatory variables in the equation to calculate LDL-C, by these two equations, DLDL-C = 0.98 TC - 0.84 HDL - 0.12 TG + 0.056 age + 0.071 BMI, and DLDL-C = 0.98 (TC- HDL) - 0.12 TG + 0.1 age + 2.4 sex + 0.2 BMI. CONCLUSION: DM and using lipid-lowering medications had no effect on the correlation of CLCL-C and DLDL-C.

The preservation of insulin sensitivity in obese women without diabetes.

OBJECTIVE: To assess insulin sensitivity, pancreatic beta-cell function, and compare circulating levels of adiponectin and ghrelin in obese women with and without diabetes. MATERIAL AND METHOD: Ninety-nine obese women with a body mass index (BMI) > or = 25 kg/m2 and age at least 40 years without previous history of diabetes participated in this study. Oral glucose tolerance test was performed in all subjects. Serum for insulin, adiponectin, and ghrelin were obtained at baseline. Data were expressed as mean +/- SEM. RESULTS: Oral glucose tolerance test revealed 66 non-diabetic (ND) and 33 diabetic (D) subjects. Despite a similar degree of obesity, women without diabetes had near normal insulin sensitivity (ND, 105.7 +/- 6.4%; D, 62.3 +/- 5.9%; p < 0.001) and beta cell function (ND, 95.4 +/- 3.0%; D, 79.0 ++/- 6.1%; p < 0.001) as assessed by the HOMA model. Non-diabetic subjects had higher serum adiponectin levels despite similar BMI (ND, 8.3 +/- 0.4 mg/ml; D, 6.3 +/- 0.4 mg/ml; p < 0.01). Obese subjects with diabetes had lower serum ghrelin levels than obese non-diabetic subjects (ND, 1027.2 +/- 32.0 pg/ml; D, 875.1 +/- 34. 6 pg/ml; p < 0.05). CONCLUSION: Obese women without diabetes have less pancreatic beta cell dysfunction and higher insulin sensitivity than obese women with diabetes. Higher circulating adiponectin may play protective roles in obese non-diabetic subjects, but the significance of higher ghrelin level should be further explored.

The relation between parameters from homeostasis model assessment and glycemic control in type 2 diabetes.

OBJECTIVE: To determine the association of insulin sensitivity and pancreatic beta-cell function parameters assessed by the homeostasis model assessment (HOMA) and glycemic control, and their potential utilization in the clinical care of patients with type 2 diabetes mellitus. MATERIAL AND METHOD: The HOMA indices were assessed in 204 (62 males, 142 females) type 2 diabetic outpatients aged 60.7 +/- 10.9 years. All patients were non-insulin treated for their diabetes. The correlation between variables including logarithmically transformed HOMA-%S and HOMA-%B, body mass index (BMI) and duration of diabetes to glycemic control were assessed The value of the disposition index (HOMA-%SxHOMA-%B) that best discriminated patients with good glycemic control (HbA1C < 7%) from those without (HbA1C > or = 7%) was determined. RESULTS: Both log (HOMA-%S) and log (HOMA-%B) were inversely related to HbA1C with comparable degrees of association (beta = -0.62, p < 0.001 and beta = -0.61, p < 0.001, respectively). The log-transformed disposition index of at least 3.57 had a sensitivity of 74.2% and a specificity of 67.6% in classifying patients as having HbA1C < 7%. The result suggested that in order to achieve acceptable glycemic control, oral hypoglycemic agents should be adjusted to maximize the likelihood of the log-transformed disposition index reaching 3.57. CONCLUSIONS: Glycemic control in diabetic patients partially depends on both insulin sensitivity and pancreatic beta-cell function. Assessing both parameters with the HOMA model is likely to result in a more rational approach for achieving better glycemic control in type 2 diabetic patients.

The development and validation of a diabetes risk score for high-risk Thai adults.

OBJECTIVE: To develop a simple risk score to identify high-risk individuals for diabetes screening in Thailand. MATERIAL AND METHOD: The authors analyzed data from 75-g oral glucose tolerance tests performed in 159 males and 270 females, aged 48.4 +/- 10.9 years. RESULTS: The independent variables associated with diabetes included age (p < 0.001), BMI (p < 0.01) and known history of hypertension (HHT) (p < 0.01). The risk equation was Y = 3 age + 5 BMI + 50 HHT. At the cut-off Y value of 240, the sensitivity and specificity for having diabetes were 96.8% and 24.0%, respectively. The positive predictive value was 17.8% and the negative predictive value was 97.8%. Using the equation in a validation group comprising 1617 subjects, it was found that 560 (34.6%) diabetes screenings could be saved while 28 subjects (12.8%) with diabetes would be missed. CONCLUSION: The authors have developed a simple risk scoring method that should be helpful in decreasing the number of unnecessary screening and optimizing the costs associated with diabetes screening.

Relationship of body composition and circulatory adiponectin to bone mineral density in young premenopausal women.

OBJECTIVE: Adiponectin is a recently discovered hormone secreted by adipocytes. Adiponectin plays an important role in the regulation of insulin sensitivity as well as the propensity to inflammation and atherosclerosis. In the present study, the authors explore the relationship between adiponectin and bone mass in premenopausal women. The relationship of fat mass compared to lean body mass to bone mass was also investigated MATERIAL AND METHOD: Two hundred premenopausal women aged between 20 and 40 years were studied. Bone mineral density (BMD) was measured at L2-4 and femoral neck by dual-energy X-ray absorptiometry (DEXA). Serum adiponectin concentrations were measured by radioimmunoassay. RESULTS: At the lumbar spines, factors associated with BMD were age (p < 0.01) and lean body mass (p < 0.001). No independent association with fat mass was demonstrated Likewise, at the femoral neck, only lean body mass was related to BMD (p < 0. 01). In terms of the relation of serum adiponectin to BMD, no association of serum adiponectin to BMD at the lumbar spines or femoral neck was found CONCLUSION: Altogether, the present findings do not suggest the independent role of adiponectin in the accrual of bone mass in females, although such a role still cannot be excluded in men or postmenopausal women.

Lack of association of VDR polymorphisms with Thai prostate cancer as compared with benign prostate hyperplasia and controls.

While still relatively low as compared to rates in the Western world, prostate cancer is on the increase in Asia, presumably due to change in dietary and other lifestyle factors. One risk factor is reported to be vitamin D (VD) and therefore the function of its receptor (VDR) could be of importance. In the present study polymorphims with functional significance in the Bsm, Apa 1 and Taq 1 genes were therefore compared in 28 prostate cancer (CaP), 44 benign prostate hyperplasia (BPH) and 30 control cases in Thailand. None demonstrated any significant variation in distribution within these three groups and therefore we conclude that vitamin D may not be major risk factor for prostate cancer in this population. However, there is considerable variation in the distribution frequencies from country to country and this, combined with differences in sun exposure, means that the results may not be extrapolated to the general case.

Association of circulating leptin with bone mineral density in males and females.

Leptin, a hormone produced by fat cells, possesses several physiological functions not limited to energy balance. Recently, leptin has been shown to inhibit bone formation through its action at the hypothalamus. In the present study, the authors explored the association of leptin with bone mineral density (BMD) in men and women according to menopausal status. Subjects consisted of 75 men, 51 premenopausal women and 63 postmenopausal women aged 20-80 years. All were healthy and did not take medication which may affect bone metabolism. BMD was measured at L2-4 and femoral neck by DEXA. Serum leptin concentrations were measured by radioimmunoassay. Serum leptin in males was independently related to BMD at L2-4 (r = -0.36, p < 0.05) and the femoral neck (r = -0.32, p < 0.05) in a multiple linear regression model with age, body mass index (BMI), serum free testosterone, estradiol and leptin as independent variables. In premenopausal women, serum leptin correlated negatively to L2-4 (r = -0.29, p < 0.01) and femoral neck BMD (r = -0.29, p < 0.05) independently of age and BMI. However, in postmenopausal women, no association of leptin with BMD was found after controlling for age and BMI. The authors concluded that circulating leptin is negatively associated with BMD in men and premenopausal women, but not in postmenopausal women. The negative associations found in both premenopausal women and men in the present study strengthen the notion that leptin may inhibit bone formation during the accumulation of bone mass early in life