Comparación de los índices triglicéridosglucosa y McAuley en el síndrome metabólico en personas con riesgo para diabetes tipo 2 / Comparison of the triglyceride-glucose and McAuley indices in metabolic syndrome in people at risk for type 2 diabetes

Resumen La prevalencia de la glucosa elevada en ayunas y la diabetes tipo 2 (DT2) está aumentando en la Argentina. Interesa encontrar índices de insulinorresistencia accesibles al laboratorio clínico con bajo costo. En 74 varones y 142 mujeres con riesgo para DT2 se analizaron los índices de McAuley y triglicéridos-glucosa (T-G) para: a) determinar los valores del índice de McAuley y su correlación con el índice T-G; b) comparar ambos índices para la detección del síndrome metabólico (SM) y su concordancia; c) determinar la asociación con los componentes de SM. Para McAuley la mediana fue 6,68 y el rango intercuartílico (5,47-8,25) y para T-G fue 8,71 (8,35-9,05) respectivamente. La correlación entre ambos fue r=-0,802, p<0,001. Respecto del SM, las áreas bajo la curva ROC fueron: índice T-G=0,816±0,029 (IC95% 0,758-0,873), p<0,001 y para el 1/índice de McAuley=0,816±0,030 (IC95% 0,758-0,874) p<0,001. La concordancia Kappa entre ambos fue 0,630, p<0,001, Chi cuadrado 85,74 (p<0,001). Para T-G y McAuley la sensibilidad fue 80,7% y 80,7%, la especificidad 70,7% y 69,4%, PP+ 62,5% y 62%, PP- 83,9 y 85,3%, la razón de probabilidad positiva (RP+) fue 2,65 y 2,64 y la negativa (RP-) fue 0,30 y 0,27 respectivamente. Ambos se asociaron con triglicéridos ≥150 mg/dL y glucosa ≥100 mg/dL y ninguno con C-HDL bajo y presión arterial ≥130/85 mmHg o en tratamiento. McAuley mostró asociación con cintura ≥102/88 cm (p>0,001). Se concluye que T-G mostró una aceptable concordancia con McAuley y ambos una similar asociación con SM. T-G podría ser útil para estudios en poblaciones pero para su aplicación en la clínica se necesitan más estudios.

Abstract The prevalence of high fasting glucose and type 2 diabetes (T2D) is increasing in our country. It is interesting to find insulin resistance indices accessible to the clinical laboratory at low cost. In 74 men and 142 women at risk for T2D, the McAuley and triglyceride-glucose (T-G) indices were analised to: a) determine the McAuley index values and they correlation with the T-G index; b) compare both indices for the detection of metabolic syndrome (MS) and their concordance; c) determine the association with MS components. For McAuley the median was 6.68 and the interquartile range (5.47-8.25) and for T-G it was 8.71 (8.35-9.05) respectively. The correlation between both was r=-0.802, p<0.001. Regarding MS, the areas under the ROC curve were: TG index=0.816±0.029 (95%CI 0.758-0.873), p<0.001 and for the 1/McAuley index=0.816±0.030 (95%CI 0.758-0.874) p<0.001. The Kappa agreement between the two indices was 0.630, p<0.001, Chi square 85.74 (p<0.001). For TG and McAuley the sensitivities were 80.7% and 80.7%, the specificities 70.7% and 69.4%, PP+ 62.5% and 62%, PP- 83.9 and 85.3%, the ratios of positive probability (PR+) were 2.65 and 2.64 and negative probability (PR-) were 0.30 and 0.27 respectively. Both were associated with triglycerides≥150 mg/dL and glucose≥100 mg/dL and neither with low HDL-C and blood pressure≥130/85 mmHg or treated. McAuley showed an association with waist≥102/88 cm (p>0.001). It is concluded that T-G showed acceptable agreement with McAuley and both similar association with SM. T-G could be useful for population studies but further studies are needed for its clinical application.

Resumo A prevalência de glicose elevada em jejum e a diabetes tipo 2 (DM2) está aumentando na Argentina. Interessanos achar índices de resistência à insulina acessíveis ao laboratório clínico a baixo custo. Em 74 homens e 142 mulheres em risco de DT2, os índices de McAuley e triglicerídeos-glicose (T-G) foram analisados para: a) determinar os valores do índice de McAuley e sua correlação com o índice T-G; b) comparar os dois índices para detecção da síndrome metabólica (SM) e sua concordância; c) determinar a associação com componentes SM. Para McAuley a mediana foi de 6,68 e o intervalo interquartil (5,47-8,25) e para T-G foi de 8,71 (8,35-9,05), respectivamente. A correlação entre os dois foi r=-0,802, p<0,001. Em relação à SM, as áreas sob a curva ROC foram: índice T-G=0,816±0,029 (IC95% 0,758-0,873), p<0,001 e para o 1/índice de McAuley=0,816±0,030 (IC95% 0,758-0,874) p<0,001. A concordância Kappa entre os dois foi de 0,630, p<0,001, Qui quadrado 85,74 (p<0,001). Para T-G e McAuley a sensibilidade foi 80,7% e 80,7%, especificidade 70,7% e 69,4%, PP+ 62,5% e 62%, PP- 83,9 e 85,3%, a razão de probabilidade positiva (RP+) foi 2,65 e 2,64 e negativa (RP-) foi de 0,30 e 0,27, respectivamente. Os dois foram associados com triglicerídeos≥150 mg/dL e glicose≥100 mg/dL e nenhum com C-HDL baixo e pressão arterial≥130/85 mmHg ou tratamento. McAuley mostrou associação com cintura≥102/88 cm (p>0,001). Conclui-se que T-G apresentou concordância aceitável com McAuley e ambos os dois associação semelhante a SM. T-G poderia ser útil para estudos populacionais, mas mais estudos são necessários para sua aplicação clínica.

Effects of hawthorn proanthocyanidins and vitamin C on kidney protection in insulin-resistance rats / 中草药

Objective To explore the effects of hawthorn proanthocyanidins (HPC) and vitamin C (VC) on kidney protection in insulin-resistance (IR) rats. Methods The IR rats were induced by high-fat diet in order to establish the model of nephropathy in type II diabetic rats, and the high-fat feeding were continued for 2 weeks after the IR rats were made. The contents of fasting blood glucose, serum insulin, glucose and microabuminuria (mAlb) in urine were tested. Fifty IR model rats were divided into model, HPC (56 mg/kg), VC (180 mg/kg), combined application of HPC (56 mg/kg) and VC (180 mg/kg), and rosiglitazone (2 mg/kg) groups. Another 10 normal rats were selected randomly to be control group. After continuous ig administration for 20 weeks in each group, these indexs, such as the levels of fasting blood glucose (FBG), serum insulin (SI), glucose in urine (24 h), creatinine (Cr), urea nitrongen (UN), uric acid (UA), were all detected. The excretion of urinary total protein (UTP), microabuminuria (mAlb), N-acetyl-β-D-glucosaminidase (NAG) were also measured. Moreover, the histopathological microstructure of kidney was observed by light microscope. Results After modeling, the levels of FBG, SI and glucose in urine increased significantly (P < 0.01) in comparation with the control group, so does the levels of UN, Cr, UA (P < 0.01) and the excretion rates of UTP, mAlb, NAG (P < 0.01). However, all these indexs were decreased significantly (P < 0.01) after the combined use of HPC and VC, which were more notable than that in HPC and VC group (P < 0.01) and equivalent to that in rosiglitazone group. Conclusion The combined application of HPC and VC can improve the renal function of IR rats and have protective effects on kidney injury.

Effect of liraglutide in treatment of non-alcoholic fatty liver disease: mechanism of action and research advances / 中华肝脏病杂志

Non-alcoholic fatty liver disease is a common chronic liver disease closely associated with obesity, hyperlipidemia, and diabetes. It can gradually progress to liver cirrhosis or even hepatocellular carcinoma; however, there are still no specific therapeutic agents for this disease. Liraglutide is a human glucagon-like peptide-1 analogue and has a marked effect in the treatment of type 2 diabetes. At present, many studies indicate that liraglutide also has a certain therapeutic effect on non-alcoholic fatty liver disease during the treatment of type 2 diabetes, but its mechanism of action remains unknown. This article reviews the known mechanisms of action of liraglutide in the treatment of non-alcoholic fatty liver disease.

Hipovitaminosis D y desarrollo de Síndrome Metabólico / Hypovitaminosis D and Metabolic Syndrome development / A deficiência de vitamina D e desenvolvimento de Sindrome Metabolica

El Síndrome Metabólico (SM) es una patología heterogénea que en rangos generales se podría definir como la combinación de factores de riesgo asociados a la enfermedad cardiovascular (ECV) y diabetes, caracterizados por insulino-resistencia, hipertensión, elevada presión arterial, elevados niveles de triglicéridos (TGL) y obesidad abdominal.La hipovitaminosis D induciría perturbaciones metabólicas (hipertensión, aterogenicidad, incremento de ECV, de insulino-resistencia, de diabetes tipo II y de obesidad central) que favorecen el desarrollo de SM. El estado nutricional respecto de la vitamina D se evalúa por los niveles de 25hidroxivitamina D (25OHD), principal metabolito circulante de dicha vitamina. Diversos estudios han sugerido la existencia de una relación inversa entre los niveles de 25OHD y el desarrollo de SM. La adiposidad central, la resistencia a la insulina y aterogenicidad son importantes factores de riesgo para el desarrollo de SM. Todos ellos se asocian a la hipovitaminosis D. La suplementación con vitamina D, al aumentar los niveles de 25OHD, reduciría el riesgo de desarrollar SM, lo que tendría importantes implicancias para el individuo en particular y la Salud Pública en general. Para clarificar todos estos puntos se hace necesario realizar estudios prospectivos randomizados, controlados, a doble ciego para evaluar los efectos a largo plazo y la causalidad entre el estado nutricional de vitamina D y el riesgo de desarrollar SM.

The metabolic syndrome (MS) is an heterophasic pathology, which in general terms, could be defined as the combination of risk factors associated with cardiovascular disease (CVD) and diabetes, characterized by insulin resistance, hypertension, high blood pressure, high levels of triglycerides (TGL) and abdominal obesity. Vitamin D deficiency may induce metabolic disturbances (hypertension, atherogeny, increased CVD, insulin-resistance, type II diabetes and central obesity), which favour the development of MS. The nutritional status for vitamin D could be evaluated by serum 25-hydroxyvitamin D levels (25OHD). Several studies have suggested the existence of an inverse relationship between 25OHD levels and the increased risk of SM. Central adiposity, insulin resistance and atherogeny are important risk factors for the development of SM. All of these factors are associated with vitamin D deficiency. Supplementation with vitamin D increases 25OHD levels and could reduce the risk of developing MS. To assess the long-term effects and the causal link between the nutritional status of vitamin D and the risk of developing MS it is necessary to perform prospective randomized, controlled, double-blind studies.

A síndrome metabólica (SM) é uma patologia heterogênea que, em termos gerais, pode ser definida como a combinação de fatores de risco associados com doença cardiovascular (DCV) e diabetes, caracterizados por resistência à insulina, hipertensão, níveis altos de pressão arterial, níveis elevados de triglicérides (TGL) e obesidade abdominal. A hipovitaminose D induziria distúrbios metabólicos (hipertensão, aterogenicidade, aumento da DCV, resistência à insulina, diabetes tipo II e obesidade central), que favorecem o desenvolvimento de SM. O estado nutricional a respeito da vitamina D é avaliado pelos níveis de 25-hidroxivitamina D (25OHD), principal metabólito circulante de tal vitamina. Vários estudos têm sugerido a existência de uma relação inversa entre os níveis de 25OHD e o desenvolvimento da SM. A adiposidade central, a resistência à insulina central e aterogenicidade são fatores de risco importantes para o desenvolvimento da SM. Todos eles se associam à hipovitaminose D. A suplementação com vitamina D, aumentando os níveis de 25OHD, reduziria o risco de desenvolvimento de SM, o que teria importantes consequências para a do indivíduo em particular e a Saúde Pública em geral. Para esclarecer todos esses pontos é necessário realizar estudos prospectivos, randomizados, controlados, duplo-cego para avaliar os efeitos no longo prazo e a causalidade entre o estado nutricional de vitamina D e o risco de desenvolver SM.

Evaluación de los niveles de lípidos y del estado de insulinorresistencia en pre- y postmenopáusicas / Evaluation of lipid levels and insulin resistance in pre- and postmenopausal women / Avaliação dos níveis de lipídios e do estado de resistência à insulina em pré- e pós-menopausa

El objetivo del trabajo consistió en evaluar la relación entre los niveles de lípidos y parámetros que definen el estado de insulinorresistencia con la edad, el estado menopáusico (EM) y el índice de masa corporal (IMC) en la pre- y postmenopausia. En este estudio de corte transversal se seleccionaron 89 mujeres: 42 premenopáusicas (Pre) y 47 postmenopáusicas (Post). Se midieron: FSH, LH, estradiol e insulina por MEIA, colesterol total (CT), triglicéridos (TG), colesterol de lipoproteínas de baja densidad (C-LDL), colesterol de lipoproteínas de alta densidad (C-HDL) y glucosa por métodos químicos convencionales. El colesterol de LDL pequeñas y densas (C-LDLpyd) se obtuvo por cálculo. Las pacientes Post mostraron niveles más elevados de CT (p<0,0001), C-LDL (p<0,0001), C-HDL (p=0,0283), TG (p=0,0014), C-LDLpyd (p=0,0001), CT/C-HDL (p=0,0016) y glucosa (p=0,0048) que las Pre. No se hallaron diferencias significativas en los valores de insulina ni del índice TG/C-HDL. El análisis de regresión múltiple mostró que los valores de CT, C-LDL y C-HDL se relacionaron lineal y positivamente con la edad. Los niveles de C-LDL medido, TG, CT/C-HDL, C-LDLpyd, glucosa, insulina y TG/C-HDL se asociaron positivamente con IMC. C-HDL se relacionó negativamente con IMC. Sólo el C-LDLpyd presentó linealidad positiva con el EM.

The purpose of this study was to evaluate the relationship between lipid levels and insulin resistance parameters with age, menopausal status (MS) and body mass index (BMI) in pre- and postmenopausal women. This cross-sectional study included 89 women: 42 premenopausal (Pre) and 47 postmenopausal (Post). FSH, LH, estradiol and insulin were measured by MEIA. Total-cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and glucose were measured by conventional clinical chemistry methods. Small and dense LDL-C (sdLDL-C) was estimated by calculation. Post women showed higher values of TC (p<0.0001), LDL-C (p<0.0001), HDL-C (p=0.0283), TG (p=0.0014), sdLDL-C (p=0.0001), TC/HDL-C ratio (p=0.0016) and glucose (p=0.0048) than Pre. Insuline and TG/HDL-C ratio were not different between groups. Multiple regression analysis showed TC, LDL-C and HDL-C levels to be linearly and positively associated to age. Measured LDL-C, TG, TC/HDL-C ratio, sdLDL-C, glucose, insulin and TG/HDL-C ratio showed linear and positive relationship with BMI. HDL-C was negatively associated to IMC. Only sdLDL-C concentrations were associated positively to MS.

O objetivo deste trabalho é avaliar a relação entre os níveis de lipídios e parâmetros que definem o estado de resistência à insulina com a idade, estado menopausal (EM) e índice de massa corporal (IMC) na pré- e pós-menopausa. Neste estudo de corte transversal, foram selecionadas 89 mulheres: 42 pré-menopausa (Pré) e 47 pós-menopausa (Pós). Foram medidos: FSH, LH, estradiol e insulina pelo MEIA. Colesterol total (CT), triglicerídeos (TG), colesterol de lipoproteínas de baixa densidade (C-LDL), colesterol de lipoproteínas de alta densidade (C-HDL) e glicose através de métodos químicos convencionais. O colesterol de LDL pequenas e densas (C-LDLpyd) foi obtido por cálculo. Pacientes Pós-menopausa apresentaram níveis mais altos de CT (p<0,0001), C-LDL (p<0,0001), C-HDL (p=0,0283), TG (p=0,0014), C-LDLpyd (p=0,0001), CT/C-HDL (p=0,0016) e glicose (p=0,0048) do que as Pré-menopausa. Não foram encontradas diferenças significativas nos valores de insulina nem do índice de TG/C-HDL. A análise de regressão múltipla mostrou que os valores de CT, C-LDL e C-HDL foram linear e positivamente relacionados com a idade. Os níveis de C-LDL medido, TG, CT/C-HDL, C-LDLpyd, glicose, insulina e TG/C-HDL foram associados positivamente com IMC. C-HDL se relacionou negativamente com IMC. Apenas o C-LDLpyd apresentou linearidade positiva com o EM.

Validation of HOMA-IR in a model of insulin-resistance induced by a high-fat diet in Wistar rats

ABSTRACT Objective The present study aimed to validate homeostasis model assessment of insulin resistance (HOMA-IR) in relation to the insulin tolerance test (ITT) in a model of insulin-resistance in Wistar rats induced by a 19-week high-fat diet. Materials and methods A total of 30 male Wistar rats weighing 200-300 g were allocated into a high-fat diet group (HFD) (55% fat-enriched chow, ad lib, n = 15) and a standard-diet group (CD) standard chow, ad lib, n = 15), for 19 weeks. ITT was determined at baseline and in the 19th week. HOMA-IR was determined between the 18-19th week in three different days and the mean was considered for analysis. Area under the curve (AUC-ITT) of the blood glucose excursion along 120 minutes after intra-peritoneal insulin injection was determined and correlated with the corresponding fasting values for HOMA-IR. Results AUC-ITT and HOMA-IR were significantly greater after 19th week in HFD compared to CD (p < 0.001 for both). AUC-OGTT was also higher in HFD rats (p = 0.003). HOMA-IR was strongly correlated (Pearson’s) with AUC-ITT r = 0.637; p < 0.0001. ROC curves of HOMA-IR and AUC-ITT showed similar sensitivity and specificity. Conclusion HOMA-IR is a valid measure to determine insulin-resistance in Wistar rats. Arch Endocrinol Metab. 2016;60(2):138-42.

Effect of hawthorn proanthocyanidins and vitimin C on liver oxidative stress in insulin-resistance rats / 中草药

Objective: To explore the effect of hawthorn proanthocyanidins (HPC) and vitimin C (VC) on liver oxidative stress in insulin-resistance rats. Methods: The insulin-resistance models were prepared by high-fat diet, the weight variations of all rats were tested before and after modeling, so were the contents of fasting blood-glucose and serum insulin after modeling. The colorimetric technique was used to test the concentration of serum ALT, AST, and ALP. The rats in high-fat diet group, who were succeeded in modeling, were divided into model, HPC (56 g/kg), VC (180 g/kg), HPC (56 g/kg) + VC (180 g/kg), and rosiglitazone (122 g/kg) groups. After 12 weeks of continuous administration, these indexes, such as levels of SOD, CAT, GSH-Px, GSH, and MDA in liver homogenates and SOD, GSH-Px, Na+, K+-ATPase, Ca2+, Mg2+-ATPase, and MDA in liver mitochondria, were all tested; RT-PCR was used to test the expression of PPAR-γ mRNA; The Western blotting method was adopted to test the PPAR-γ protein expression. Results: After modeling, the body weight of rats decreased significantly (P<0.05), the concentration of blood, such as glucose, serum insulin ALT, AST, and ALP all increased significantly (P<0.01); The model group was compared with control group, the activities of SOD, CAT, GSH-Px, and GSH were significantly decreased (P<0.01), the levels of glucose, insulin, and MDA increased significantly (P<0.01) in rat liver homogenate, the activities of SOD, GSH-Px, Na+, K+-ATPase, and Ca2+, Mg2+-ATPase were significantly decreased (P<0.01) and MDA level increased significantly (P<0.01) in the liver mitochondria; PPAR-γ mRNA and protein expression decreased significantly in liver tissue (P<0.01). HPC, VC, HPC + VC, and rosiglitazone improved the above indexes, which in the HPC + VC group was better than that in the HPC group and VC group, equivalent to that in rosiglitazone group. Conclusion: Liver oxidative stress which is resulted from insulin-resistance can be improved when HPC and VC are combined.

Protective effect of chrysin on mice with insulin resistance / 中国病理生理杂志

[ABSTRACT]AIM:Toexploretheeffectsofchrysinoninsulinresistance(IRe)inamousemodel.METHODS:Male C57 mice were randomly divided into control group , IRe group, low-dose chrysin group ( IRe+chrysin-low) and high-dose chrysin group (IRe+chrysin-high).After 24 weeks, the body weight, liver index and fat mass in all mice were detected.The blood glucose , insulin level and HOMA-IR were measured to determine the changes of the insulin resistance in the animals.The oxidative stress (SOD, GSH-Px and MDA) was also measured.The mRNA expression of insulin sig-naling pathway molecules (IR, IRS1, IRS2, Glut2 and Glut4) and inflammatory factors (TNF-α, IL-1β, IL-6 and NF-κB) was analyzed by real-time PCR.The protein levels of IRS1 and p65, and their phosphorylation were detected by West-ern blot.RESULTS:After 24-week intervention , the indicators in IRe group were higher than those in control group , in-cluding body fat deposition, serum glucose, serum insulin, HOMA-IR and liver oxidative stress (P<0.01), indicating that the model of insulin resistance was successfully established .Low dose and high dose of chrysin decreased the body weight, serum glucose, serum insulin and HOMA-IR in the IRe mice (P<0.05).The liver oxidative stress was also re-duced in both groups (P<0.05).However, no statistical difference of the indexes between IRe +chrysin-low group and IRe+chrysin-high group was observed.Chrysin upregulated the mRNA expression of IR , IRS1, IRS2, Glut2 and Glut4 (P<0.05), and down-regulated the mRNA expression of various inflammatory factors .The inhibitory effect of chrysin on the mRNA expression of NF-κB was observed (P<0.05), especially in high dose group (P<0.05).It was confirmed that the effect of chrysin on liver IRe was related with the increase in the p-IRS1 levels and decrease in the p-p65 levels by Western blot .CONCLUSION:Chrysin inhibits obesity , hyperglycemia and hyperinsulinemia , and relieves insulin resist-ance and oxidative stress , which might be closely related to the regulation of insulin signaling pathway and the inhibition of inflammatory factor expression .

Obesidad e hígado graso no alcohólico / Obesity and non-alcoholic fatty liver disease

Obesity is closely related to the genesis of non-alcoholic fatty liver disease (NAFLD). Thus, due to the obesity epidemic, NAFLD has emerged as a major cause of liver disease worldwide. The inflammatory form of NAFLD [termed non-alcoholic steatohepatitis] can progress to more advanced stages of chronic liver disease, including cirrhosis in up to 25 percent of cases in one or two decades. Moreover, recent data have identified NAFLD as a significant risk factor for development of cardiovascular events and type 2 diabetes mellitus. Though NAFLD pathophysiology is not completely understood, insulin resistance (IR) has been identified as a central event involved in the pathogenesis and progression of the disease. Consequently, the focus of therapy should be aimed to reduce IR, including weight loss, increase in physical activity, and in some cases pharmacological agents. This article summarizes current concepts of NAFLD and its relationship to the epidemic of obesity.

La obesidad está estrechamente vinculada a la génesis del hígado graso no alcohólico (HGNA), esto explica por qué esta entidad ha emergido como una de las principales causas de enfermedad hepática a nivel mundial. La forma inflamatoria del HGNA, llamada esteatohepatitis no alcohólica, puede progresar a estadios más avanzados de enfermedad hepática crónica, incluyendo la cirrosis en hasta 25 por ciento de los casos en una o dos décadas. Además, datos recientes han identificado al HGNA como un factor de riesgo relevante para el desarrollo de eventos cardiovasculares y diabetes mellitus tipo 2. Aunque la fisiopatología del HGNA no ha sido completamente aclarada, la insulino-resistencia (IR) ha sido identificada como un evento central involucrado tanto en la génesis como en la progresión de la enfermedad. En consecuencia, el foco de la terapia debe ser dirigido a medidas que propendan a la baja de peso y a reducir la IR. El presente artículo revisa en forma somera los conceptos actuales sobre HGNA y su relación con la epidemia de la obesidad.

Insulinorresistencia, obesidad y síndrome metabólico. Cohorte CDC de Canarias en Venezuela / Insulin resistence, obesity and metabolic síndrome. Cohort CDC Canarian in Venezuela

La obesidad es una enfermedad crónica, problema de salud pública, con alta morbilidad asociada a resistencia a la insulina (RI). El síndromemetabólico (SM) predice enfermedad cardiovascular y diabetes tipo 2, siendo la obesidad y la RI los principales factores de riesgo. El HOMA es un indicador validado de RI simple, de bajo costo y poco invasivo. El objetivo fue determinar RI (HOMA) y su relación con el estado nutricional, en adultos canario-venezolanos con y sin diagnóstico de SM. La muestra incluyó 67 personas (20-84 años), canarios e hijos mayores de 19 años residentes en Venezuela, 23 con SM y 44 controles. Se determinó antropometría, presión arterial y análisis en ayuno de glucosa, HDL-colesterol, triglicéridos e insulina. Los obesos, en comparación con los eutróficos, presentaron valores significativamente superiores de HOMA (3,63 ± 1,27 vs 2,33 ± 0,52, p<0,001) así como de circunferencia de cintura, presión arterial diastólica, triglicéridos, glucosa, insulina y del índice triglicéridos/HDL-colesterol. La prueba de Chi² mostró asociación altamente significativa (p<0,001) entre HOMA y SM.Los sujetos con SM demostraron tener 4,7 veces más riesgo de tener RI, siendo este hallazgo estadísticamente significativo. Para establecer la correlación entre las variables el análisis de Pearson demostró una correlación significativa (p<0,001) entre HOMA y el índice de masa corporal, circunferencia abdominal, triglicéridos e Índice Triglicéridos/HDL-colesterol. La obesidad mostró alta asociación con insulino-resistencia. Concluyendo que la obesidad, la hipertrigliceridemia y el índice Triglicéridos/HDL-colesterol elevado son parametros para RI.

Obesity is a chronic disease, a public health problem, with high morbidity associated to the insulin resistance (IR). Metabolic syndrome (MS), predicts cardiovascular disease and type 2 diabetes, being obesity and IR the main risk factors. HOMA, is a simple validated marker for IR, non invasive and inexpensive. The objective was to estimate IR and its relation with the nutritional status of canarian-venezuelan adults with and without MS. The sample was comprised of 67 adults (20-84 years old), born in canaries islands and their children older than 19 years of age living in Venezuela, 23 with MS and 44 controls. Anthropometric measurements, blood pressure, fasting glucose, HDL-cholesterol, triglycerides and insulin were performed in each individual. Subjects with obesity showed significantly higher values of HOMA (3,63 ± 1,27 vs 2,33 ± 0,52, p<0,001) as well as abdominal circumference, diastolic blood pressure, triglycerides, glucose, insulin and triglycerides/HDLcholesterol, when compared to the eutrophic subjects,. The Chi² test showed a highly significant association (p<0,001) between HOMA and MS. MS subjects had 4.7 times more risk for IR, being this finding statistically significant. To establish the correlation between variables was performed Pearson analysis demonstrating a significant correlation between HOMA and body mass index (BMI), abdominal circumference, triglycerides and triglycerides/ HDL-cholesterol. Obesity showed a high association with insulinresistance. Concluding that obesity, hypertriglyceridemia and high index triglycerides/HDL-cholesterol are high parameters for RI.

Caracterización de niños y adolescentes obesos con síndrome metabólico / Characterization of obese children and adolescents with metabolic syndrome

Introducción: el síndrome metabólico es más frecuente en niños y adolescentes con obesidad. Objetivo: determinar algunas características clínicas, antropométricas y de laboratorio en niños obesos con síndrome metabólico. Métodos: estudio transversal con 59 niños y adolescentes obesos con edades entre 2 y 14 años, seleccionados por muestreo aleatorio simple de 20 consultorios del municipio Urbano Noris, de Holguín, atendidos en abril-mayo de 2010. Las variables fueron: sexo, edad, peso, talla, índice de masa corporal, circunferencia abdominal, presión arterial, colesterol total, triglicéridos, glucemia, HDL-colesterol, LDL-colesterol, microalbuminuria y los índices colesterol total/HDL-colesterol y LDL-colesterol/HDL-colesterol, además, la presencia de hipertensión arterial y diabetes mellitus. Se empleó el análisis de varianza y la prueba c2 en SPSS y nivel de significación del 0,05. La pesquisa se realizó según los criterios cubanos basados en el Programa Nacional de Educación sobre el Colesterol de Estados Unidos. Resultados: la frecuencia del síndrome metabólico fue del 55,9 %. Estos pacientes presentaron valores superiores de la presión arterial, los triglicéridos, la glucemia, LDL-colesterol y de los índices aterogénicos y concentraciones más bajas de lipoproteínas de alta densidad, que el grupo sin síndrome metabólico (n= 26). Se encontró una asociación significativa entre el síndrome metabólico y la hipertensión arterial, no así con la microalbuminuria y la diabetes mellitus. No se encontraron diferencias de género. Conclusiones: es importante el diagnóstico del síndrome metabólico en niños y adolescentes para una mejor caracterización de este estado, y se recomienda una intervención basada en cambios de estilos de vida.

Introduction: the metabolic syndrome is more frequent in children and adolescents with obesity. Objective: to determine some clinical, anthropometry and laboratory features in obese children with metabolic syndrome. Methods: a cross-sectional study was conducted in 59 obese children and adolescents aged between 2 and 14, selected by randomized sampling of 20 consulting rooms from the "Urbano Noris" municipality, Holguín province seen in April-May, 2010. Variables included: sex, age, weight, height, body mass index (BMI), abdominal circumference, blood pressure, total cholesterol, triglycerides, glycemia, HDL-cholesterol, LDL-cholesterol, microalbuminuria and the total cholesterol rates/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol, as well as the presence of a high blood pressure and diabetes mellitus. Variance analysis was used and also the c2 test in SPSS and the significance level of 0.05. Screening was carried out according to the Cuban criteria based on the National Program of Education on the Cholesterol of United States. Results: the frequency of metabolic syndrome was of 55.9 %. These ones had high values of blood pressure, triglycerides, glycemia, LDL-cholesterol and the atherogenic rates and concentrations of high-density lipoproteins lower than the group without metabolic syndrome (n= 26). There was a significant association between the metabolic syndrome and the high blood pressure, but not with the microalbuminuria and diabetes mellitus. There were not gender differences. Conclusions: the diagnosis of the metabolic syndrome is very important in children and adolescents to a better characterization of this stage and it is recommended an intervention based on the changes in the lifestyles.

Prevalencia de Insulinorresistencia en adolescentes de la ciudad de Posadas: criterios diagnósticos recomendados / Prevalence of Insulin Resistance in adolescents in the city of Posadas: recommended diagnostic criteria

Existe un creciente reconocimiento del importante papel de la insulinorresistencia (IR) en la patogénesis de la diabetes tipo 2 en niños y adolescentes. Nos propusimos obtener los percentilos de referencia y la prevalencia de insulinemia en ayunas e índices de IR, HOMA y QUICKI en adolescentes escolarizados de la ciudad de Posadas-Misiones. Se realizó un estudio descriptivo transversal en 420 estudiantes de nivel secundario. Se evaluaron parámetros antropométricos, circunferencia de cintura y presión arterial. Se realizó una extracción sanguínea con 12 horas de ayuno para las determinaciones bioquímicas: glucemia, perfil lipídico e insulina. Las muestras fueron procesadas con control de calidad interno y externo. Se encontró que el percentilo 95 de Insulina fue ≥ 12 mU/lt y de HOMA ≥ 2,5 y percentilo 5 para QUICKI ≤ 0.33. De la comparación entre sexos, no se halló diferencias significativas en los valores de los índices HOMA y QUICKI (U = 3077, p = 0,058), pero con Insulina se observaron diferencias significativas, mujeres = 8,59 ± 2,93 mU/l vs. varones = 6,50 ± 2,55 mU/l (U = 2929; p = 0,019). Sin embargo, al aplicar la prueba z y el 1,5 del DE, no sería necesario el cálculo para grupos separados por sexo (z calculado = 2,63; z crítico = 2,47; 1,5 DE = 3,82 mU/l). 11,7 % presentó Hiperinsulinemia y la prevalencia de IR según HOMA fue 10,5 % y 9,8 %, por QUICKI, sin diferencias estadísticas según sexo y grupo de edad. Insulinemia y ambos índices de IR estaban significativamente más elevados en los adolescentes con sobrepeso u obesos. Estos valores podrán ser utilizados como guía en el algoritmo diagnóstico de IR por parte de la comunidad médica.

Introduction: There is a growing recognition of the important role of insulin resistance (IR) in the pathogenesis of type 2 diabetes in children and adolescents. The aim of this study was to obtain the reference percentiles and the prevalence of fasting insulin and index of IR, HOMA and QUICKI, in adolescents in the city of Posadas, Misiones. Materials and Methods: A descriptive study of 420 high-school students was performed. Anthropometric parameters, waist circumference and blood pressure were evaluated. Blood samples were taken after 12 hours fasting for biochemical measurements: fasting glucose, lipid profile and insulin. The samples were processed in-house and external quality control. Results: Percentile 95 of Insulin ≥ 12 mU/lt, HOMA ≥ 2.5 and percentile 5 for QUICKI was ≤ 0.33. Comparison between genders showed no significant differences in HOMA and QUICKI values (U = 3077, p = 0.058), but significant differences were found for insulin: females = 8.59 ± 2.93 mU/l, males = 6.50 ± 2.55 mU/l (U = 2929, P = 0.019), However, when applying the z test and 1.5 of SD, calculation for groups separated by gender would not be necessary (calculated z = 2.63, critical z = 2.47, 1.5 SD = 3.82 mU/l). 11.7 % were hyperinsulinemic and the prevalence of IR by HOMA was 10.5 % and 9.8 % for QUICKI, with no statistical differences by sex and age group. Insulin and two indexes of IR were significantly higher in overweight or obese adolescents. Conclusions: These values may be used as a guide in the diagnostic algorithm of IR by the medical community.

Evaluación de las alteraciones lipídicas en el síndrome de ovarios poliquísticos y su relación con la resistencia a la insulina / Assessment of the lipid alterations in polycystic ovaries syndrome and its relation to insulin-resistance

El síndrome de ovarios poliquísticos excede el eje reproductivo por su frecuente asociación con alteraciones metabólicas y cardiovasculares. Objetivo: basado en lo anterior se realizó un estudio descriptivo transversal para determinar la frecuencia y las características de las alteraciones lipídicas en un grupo de mujeres con síndrome de ovarios poliquísticos y su relación con las alteraciones en la sensibilidad a la insulina. Se estudiaron 23 mujeres según los criterios de la Androgen Excess Society, se realizaron determinaciones hormonales y lipídicas así como glucemia e insulinemia en ayunas para evaluar sensibilidad a la insulina. Resultados: 95,6 por ciento de las pacientes presentaron dislipidemia. La disminución de las lipoproteínas de alta densidad (cHDL) y apolipoproteínas (Apo) A-I fueron las alteraciones lipídicas más frecuentes (91,3 y 87,0 por ciento, respectivamente) mientras que el aumento de los triglicéridos (Tg) y del colesterol total (Ct) fueron infrecuentes (13 y 4,3 por ciento, respectivamente). Los índices lipídicos calculados: Tg/cHDL, Ct/cHDL, cHDL/cLDL y Apo B/A-I tuvieron valores medios superiores en las mujeres con insulinorresistencia, el índice Apo B/A-I fue el que mostró mayor diferencia en mujeres con insulinorresistencia y sin esta. La frecuencia de las alteraciones lipídicas en las mujeres estudiadas fue alta pero no todas se relacionan con la insulinorresistencia, lo cual sugiere que en la expresión del síndrome de ovarios poliquísticos podrían intervenir múltiples factores metabólicos y hormonales(AU)

The polycystic ovaries syndrome to exceed the reproductive axis due to its frequent association with metabolic and cardiovascular alterations. Objetive: based on above mentioned a cross-sectional and descriptive study was conducted to determine the frequency and the characteristic of lipid alterations en a group of women diagnosed with polycystic ovaries and its relation to alterations in insulin-sensitivity. Methods: twenty three women were studied according to Androgen Excess Society criteria, hormonal and lipid determinations were made as well as fasting glycemia and insulinemia to assess the insulin-sensitivity. RESULTS: the 95,6 percent of patients presenting with dyslipemia. The more frequent lipid alterations were a decrease of the high density lipoproteins (cHDL) and apolipoproteins (Apo) (91,3 and 87,0 percent, respectively) whereas the increase of triglycerides(Tg) and the total cholesterol (tC) were infrequent (13 and 4,3 percent, respectively). The estimated lipid rates: Tg/cHDL, Ct/cHDL, cHDL/cLDL and Apo B/A-I had higher mean values in women with insulin-resistance; the Apo B/A-I rate had the greater difference in women with insulin-resistance and without it. The lipid alterations frequency in study women suggest that in expression of polycystic ovaries syndrome could be involved many metabolic and hormonal factors(AU)

Changes of fibroblast growth factor-21 and its receptors in high-fat diet fed apoE~(-/-) mice / 中华内分泌代谢杂志

Objective To investigate the effects of high-fat diet induced insulin resistance on fibroblast growth factor-21 (FGF-21) and its receptors expression in ApoE~(-/-) mice. Method Male ApoE~(-/-) mice were randomly divided into normal-chow group(NF,n=20)and high-fat fed group(HF,n=20) and fed for 16 weeks. The insulin sensitivity and glucose-lipid metabolism in awake mice were evaluated by hyperinsulinemic-euglycemic clamp technique combined with 3-[~3H]-glucose as a tracer. The Mrna expressions of FGF-21,β-klotho, and FGFR1-4 were measured by quantitative real-time PCR. FGF-21 protein levels were determined by Western blot. Results Fasting blood glucose, plasma insulin and free fatty acids, triglycerides, free fatty acids, and cholesterols were significantly elevated in HF group compared with NF group(all P<0.01). During the steady-state of clamp, plasma insulin was significantly higher in HF group than that in NF group(P<0.01), and glucose infusion rate was also significantly decreased(P<0.01). At the end of insulin clamp, glucose disappearance rate was significantly lower in HF group than that in NF groups(P<0.01). Hepatic glucose production in NF group was suppressed by 70% ,while in HF group it was suppressed by 51%. The FGF-21 Mrna expressions of hepatic and adipose tissues in HF group were significantly increased compared with NF group(both P<0.01), and β-klotho Mrna expressions increased(P<0. 05). In hepatic and adipose tissues, FGFRI, Mrna expressions were higher in HF group than those in NF group(both P<0.01) ,and FGFR3 Mrna increased(P<0.01 and P<0.05, respectively). In hepatic tissue,FGFR4 Mrna levels were significantly up-regulated in HF group(P<0. 05). Plasma FGF-21 levels were elevated in HF group compared with NF group(P<0.01) ,and FGF-21 protein expressions of hepatic and adipose tissues were also increased(both P<0.05). Conclusion FGF-21, β-klotho, FGFR1, and FGFR3 were significantly up-regulated in ApoE~(-/-) mice fed by high-fat diet, and they might be the targets in regulating glucose-lipid metabolism by FGF-21.

Complicaciones cardiovasculares perioperatorias en pacientes portadores de síndrome metabólico / Perioperative cardiovascular complications present in patients carriers of metabolic syndrome

Introducción: Se realizó un estudio de cohorte prospectivo, con el objetivo de evaluar la influencia del síndrome metabólico en la aparición de complicaciones cardiovasculares perioperatorias. Objetivos: identificar como contribuyó el síndrome metabólico al incremento de la incidencia de complicaciones cardiovasculares perioperatorias en pacientes quirúrgicos. Método: La selección de la muestra se realizó de forma sistemática en el HMC Dr. Luis Díaz Soto y se conformaron: 1 grupo de 38 pacientes compuesto por individuos portadores de síndrome metabólico y otro de 42 pacientes no portadores de esta enfermedad. Ambos grupos se sometieron a cirugía abdominal con anestesia general endotraqueal. Las principales variables analizadas fueron: tensión arterial sistólica, media y diastólica, frecuencia cardíaca y el trazado electro cardiográfico. Resultados: La hipertensión arterial sistodiastólica, y los trastornos del ritmo cardiaco, en particular las contracciones prematuras supraventriculares y ventriculares fueron las alteraciones detectadas con mayor frecuencia en los pacientes con síndrome metabólico, mostrándose diferencias significativas (p< 0,05) entre los dos grupos. Conclusiones: El síndrome metabólico predispone a la aparición de complicaciones cardiovasculares perioperatorias, además de estar presente de manera frecuente, en pacientes quirúrgicos tributarios de intervención anestesiológica.

Introduction: A prospective cohort study was conducted to assess the influence of metabolic syndrome on appearance of perioperative cardiovascular complications. Aims: To identify how the metabolic syndrome contributed to increase of above mentioned complications in surgical patients. Method: Sample selection was carried out in a systemic way in the "Dr. Luís Díaz Soto" Central Military Hospital including three groups: Group I (38 patients) composed of subjects carriers of metabolic syndrome and another one (42 patients) composed of non-carriers of this condition. Both groups underwent abdominal surgery placed under endothracheal general anesthesia. Main analyzed variables were: systolic, mean and diastolic arterial tension and cardiac rhythm disorders, heart rate and electrocardiographic tracing. Results: Systolic-diastolic arterial hypertension and the cardiac rhythm disorders particularly, the supraventricular early contractions were the more frequent disturbances present in patients presenting with metabolic syndrome with significant differences (p < 0,05) between both groups. Conclusions: Metabolic syndrome predisposes to appearance of perioperative cardiovascular complications as well as being frequently present in surgical patients requiring anesthesia intervention.

Trastornos de la glucemia y de la acción de la insulina en una población de riesgo de diabetes / Glycemia and insulin action disturbances in diabetes-risk population

OBJETIVO: conocer la frecuencia de hiperglucemia y resistencia a la insulina en un grupo de pacientes con riesgo de padecer trastornos del metabolismo de los carbohidratos. MÉTODOS: se realizó un estudio transversal descriptivo en una población del policlínico Reina, se estudiaron 118 pacientes, a los que se les midieron glucemia de ayuno y posprandial, después de una carga oral de glucosa e insulinemia. Se aplicó el índice de HOMA-IR para el cálculo de la insulinorresistencia. RESULTADOS: se obtuvo 5,1 porciento de pacientes con diabetes, todos mayores de 60 años de edad e hipertensos; 25,4 porciento de la muestra mostró algún grado de hiperglucemia en el rango de prediabetes. Los trastornos de la glucemia se incrementaron de manera paralela al aumento de la edad (p= 0,005). La insulinorresistencia fue detectada en 21,2 porciento del total de pacientes incluidos y en 53,8 porciento de los que presentaron algún trastorno del metabolismo hidrocarbonado; resultó aún más relevante en los pacientes con diabetes, en los que afectó a 83,3 porciento (p= 0,001). CONCLUSIONES: los trastornos asociados a la hiperglucemia asintomática y la resistencia a la insulina, asociada a la hiperglucemia, son frecuentes en la práctica clínica cuando se estudian grupos de riesgo de padecer diabetes(AU)

OBJECTIVE: to know the hyperglycemia frequency and resistance to insulin in a group of patients with risk of carbohydrates metabolism disturbances. METHODS: a cross-sectional and descriptive study was conducted in a population from the Reina polyclinic. A total of 118 patients were studied to measure the fast and postprandial glycemia after an oral load of glucose e insulinemia. For insulin-resistance calculus HOMA-IR index was applied. RESULTS: there was a 5.1 percent of diabetic patients aged over 60 and hypertensive; 25.4 percent of sample showed some degree of hyperglycemia in the pre-diabetes rank. Glycemia disturbances increased in a parallel way to age increase (p= 0.005). Insulin-resistance was detected in 21,2 percent of total of included patients and in 53.8 per of those presenting with some hydrocarbon metabolism disturbance being more marked in diabetic patients affecting to 83.3 percent (p= 0.001). CONCLUSIONS: hyperglycemia-associated disturbances and insulin-resistance associated with hyperglycemia are frequent in clinical practice when risk group are studied due to diabetes(AU)

Insulino resistencia y síndrome metabólico en pacientes con enfermedad coronaria definida por angiografía / Insulin-resistance and metabolic syndrome in patients with coronary heart disease defined by angiography

Se examinó la frecuencia de insulino-resistencia (IR) y síndrome metabólico (SM) en pacientes coronarios empleando diferentes criterios de definición y se analizó cuáles mostraban mejor asociación con la presencia y gravedad de la afección. Fue un estudio casos-controles en 100 pacientes con edades entre 40 y 70 años que concurrieron a un centro hospitalario para realizarse una angiografía. IR fue definido por insulina >15 mU/l, el modelo hemostático de insulino-resistencia (HOMA-IR) >3.1 y la combinación del índice de masa corporal (IMC) >27.5 kg/m² con HOMA-IR >3.6. SM fue definido según International Diabetes Federation y American Heart Association / National Heart, Lung, and Blood. Insulina >15 mU/l y HOMA-IR >3.1 tuvieron la misma sensibilidad, (60.3%), y se asociaron significativamente con la extensión de la enfermedad coronaria, p = 0.001 y p = 0.009 respectivamente. En cambio, IMC >27.5 kg/m² con HOMA-IR >3.6 mostró menor sensibilidad, (43.1%), y menor asociación con la gravedad, (p = 0.028). Los odds ratio (OR) para enfermedad coronaria fueron respectivamente: 3.16 (IC 95% 1.28-7.79), p = 0.012; 2.93 (IC 95% 1.20-7.19) p = 0.019; 2.86 (IC 95% 1.10-7.41), P = 0.031. La frecuencia de SM definida según American Heart Association / National Heart, Lung, and Blood fue mayor en coronarios versus controles (62.1% versus 33.3%, p = 0.003), se asoció con la enfermedad en uno o en múltiples vasos (p = 0.011) y fue su predictor, OR = 4.22 (IC 95% 1.65-10.83) p = 0.003. Sin embargo, SM definido según International Diabetes Federation no se asoció con la presencia ni con la gravedad de la enfermedad.

The frequency of insulin-resistance (IR) and metabolic syndrome (MS) were examined in coronary patients using different criteria of definition. It was also analyzed which of them indicated a strong association with the presence and severity of the disease. This was a case-control study on 100 patients between 40 and 70 years old, assisted in a hospital center and there examined by angiography. IR was defined by insulin >15 mU/l, Homeostatic Model Assessment for insulin-resistance (HOMA-IR) >3.1 and the combination body mass index (BMI) >27.5 kg/m² with HOMA-IR >3.6. MS was defined according to International Diabetes Federation and American Heart Association/National Heart, Lung and Blood Institute. Insulin >15 mU/l and HOMA-IR >3.1 had similar sensibility, 60.3%, and were significantly associated with the extension of coronary heart disease, p = 0.001 and p = 0.009 respectively. Whereas, BMI>27.5 kg/m² with HOMA-IR>3.6 showed a lower sensibility, 43.1% and less association with severity, p = 0.028. The odds ratio (OR) for coronary heart disease were respectively: 3.16 (CI 95 1.28-7.79), p = 0.012; 2.93 (CI 95% 1.20-7.19) p = 0.019; 2.86 (CI 95% 1.10- 7.41), p = 0.031. The frequency of SM defined according to American Heart Association/National Heart, Lung and Blood Institute was higher in coronary patients vs. controls (62.1% vs. 33.3%, p = 0.003). It was associated with disease in one or more vases (p = 0.011) and was its predictor, OR = 4.22 (CI 95% 1.65-10.83) p = 0.003. However, SM defined according to International Diabetes Federation was not associated with the presence or severity of coronary heart disease.

Interacción entre leptina y grelina como parte del control tónico de la ingesta de alimentos / Interaction between leptin and ghrelin as part of tonic control of food intake

Food intake is regulated by an acute control system that conveys information between the stomach and hypothalamic centres of feeding regulation mainly via neural vagal afferent fibers for satiety and via hormonal signal transmission by ghrelin for recurrence of appetite and hunger. This acute system is under tonic control by adipocyte-derived leptin as an indicator of the nutritional status of the organism. In obese subjects plasma leptin is higher compared to normal weight subjects (NW). This is associated with lower ghrelin levels suggesting that the negative feedback loop to reduce food intake in the case of sufficient energy reserves is intact. A differential analysis of the inverse relationship between leptin and ghrelin, however, suggests an inhibitory effect of leptin is restricted to male normal and overweight subjects. In females and obese subjects of both genders this inverse relationship does exist. These findings indicate that the position of ghrelin within the control system of food intake is somewhat more sophisticated than previously thought and it requires more detailed analysis

La ingesta de alimentos está regulada por un sistema de control inmediato que transmite información entre el estómago y los centros hipotalámicos de regulación de la alimentación, principalmente a través de fibras aferentes vagales nerviosas para la saciedad y mediante la transmisión de señales hormonales de la grelina para la recurrencia del apetito y el hambre. Este sistema inmediato se encuentra bajo control tónico de la leptina derivada de los adipocitos como indicador del estado nutricional del organismo. En los individuos obesos la leptina plasmática es más alta en comparación con los individuos de peso normal. Esto se asocia con concentraciones más bajas de grelina, lo que sugiere que el asa de retroalimentación negativa para reducir la ingesta de alimento en el caso de reservas suficientes de energía está intacta. Sin embargo, el diagnóstico diferencial de la relación inversa entre leptina y grelina sugiere que el efecto inhibidor de la leptina está restringido a hombres normales y con sobrepeso. En las mujeres y en los individuos obesos de ambos sexos existe esta relación inversa. Estos hallazgos indican que la posición de la grelina dentro del sistema de control de la ingesta de alimentos es algo más sofisticada de lo que antes se creía y requiere un análisis más detallado

Cambios hemodinamicos precoces en pacientes con resistencia insulínica

Objetivos: Determinar cambios hemodinámicos, estructurales y funcionales de pacientes con resistencia insulínica y sin síndrome metabólico. Métodos: Se seleccionaron diez pacientes de ambos sexos con diagnóstico de resistencia insulínica. Diez pacientes sanos ajustados por edad, sexo e índice de masa corporal (IMC) constituyeron el grupo control. El IMC y la presión arterial fueron registrados. Los pacientes fueron sometidos a una prueba de tolerancia oral a la glucosa. El índice de HOMAIR fue utilizado para el cálculo de la resistencia insulínica (HOMAIR: valor ≥ 2,5). La concentración de norepinefrina plasmática (NE) se cuantifico por HPLC. Los parámetros hemodinámicos, estructurales y funcionales del corazón fueron evaluados mediante el ecocardiograma bidimensional, eco doppler pulsado y doppler pulsado tisular. Resultados: La glucemia, la insulina basal y post-carga y el HOMAIR fueron significativamente más altos en el grupo de pacientes. El índice cardiaco resultó significativamente más bajo en el grupo de pacientes. La concentración de NE se correlacionó en forma positiva y estadísticamente significativa con las concentraciones de insulina basal y post-carga. La presión arterial diastólica se correlacionó en forma negativa y estadísticamente significativa con la insulina post-carga solo en el grupo control. El volumen diastólico final del ventrículo izquierdo se correlacionó en forma positiva y estadísticamente significativa con la insulina y el HOMAIR en el grupo de pacientes pero no en el grupo control. Conclusiones: Los niveles de insulina plasmática podrían desempeñar un papel muy importante en la modulación de los niveles plasmáticos de NE en pacientes con resistencia insulínica. La sobreactivación del sistema nervioso simpático podría condicionar anormalidades en el volumen sistólico final y el índice cardiaco, los cuales constituirían los cambios hemodinámicos adaptativos precoces en pacientes con resistencia insulínica sin síndrome metabólico.

Objective: To determine the haemodynamic, structural and functional changes in insulin-resistant subjects Methods: Ten insulin-resistant subjects were studied. Asymptomatic subjects were studied as a control group. Blood pressure and body mass index were registered. Standard oral glucose tolerance test was performed. Plasma glucose and insulin were measured at baseline and 2 hours post glucose load. Insulin resistance index HOMAIR was calculated. Insulin resistance was considered if HOMAIR value was ≥ 2.5. Plasma norepinephrine (NE) was measured by HPLC. In order to examine the mass and cardiac function, bi-dimensional echocardiogram and imaging doppler tissue were performed. Results: Plasma glucose, insulin and HOMAIR were significantly higher in insulin-resistant subjects. There was no significant difference in plasma NE concentration between groups. The cardiac index was the only haemodynamic variable found to be significantly lowers in insulin resistant subjects. A significant positive correlation between NE with fasting and post load insulin concentration was observed. In control group, a significant negative correlation between diastolic blood pressure and post load insulin concentration was observed. The left ventricle systolic end-volume was positively and significantly correlated with insulin and HOMAIR in insulin-resistant subjects, but not in controls. Conclusions: Insulin levels may play role in modulating plasma NE levels, particularly in insulin-resistant subjects. The increased sympathetic activity in these subjects might lead to an abnormality in the left ventricle systolic end-volume and cardiac index, which might be the earlier adaptative haemodynamic changes due to cardiac post-load.

Effect of Insulin Resistance on Dietary Interventions in People with Abnormal Blood Glucose / 中国慢性病预防与控制

Objective To investigate the effect of insulin resistance(IR) on the persons with abnormal blood glucose who underwent dietary interventions.Methods 194 individuals with abnormal blood glucose were selected from hyperlipidemia population taking the community intervention program in districts of Beijing.The insulin resistance and insulin action index(IAI) were calculated with fasting blood glucose(FBG) and fasting blood insulin(FINS),and analyzed the relationship of variety on their blood glucose,serum lipids and body weight,body mass index(BMI),waist circumference,waist hip ratio(WHR).Results 1) Blood glucose(FBG),triglyceride(TG),waist circumference and WHR had significant positive relationship with IR but negative with IAI;2) In the intervention group,FBG and TG were reduced significantly in the subgroup with highest IAI.Conclusions IR was related with blood glucose,serum lipids,waist circumference and WHR,but no significant relation with body weight and BMI;It was possible that IR had some effect on dietary intervention.