Síndrome metabólico en el adulto mayor vinculado a los programas de actividad física comunitaria / Metabolic Syndrome in the Elderly Adult Involved in the Community Physical Activity Programs

Introducción: El síndrome metabólico es una situación clínica compleja que se asocia a un incremento de la morbilidad y mortalidad. Los elementos que lo componen aumentan el riesgo de diabetes mellitus tipo II y enfermedad cardiovascular. Objetivo: Determinar el comportamiento del síndrome metabólico en el adulto mayor vinculado a los programas de actividad física comunitaria del proyecto Lindo Amanecer del municipio Arroyo Naranjo. Métodos: Se realizó un estudio observacional descriptivo de corte transversal. El universo de estudio lo constituyeron 120 adultos mayores, de los que se entrevistaron a 106, en el período de abril a octubre de 2018. Se siguieron los criterios del Adult Treatment Panel III para el diagnóstico de síndrome metabólico. Las variables descriptivas se expresaron en porcientos y para la comparación de variables en estudio se utilizó el método estadístico de ji al cuadrado. Resultados: Los resultados obtenidos mostraron un 41,51 por ciento de personas con síndrome metabólico, predominaron las personas de 70 y más años de edad (54,54 por ciento y el sexo femenino (93,18 por ciento). El 100 por ciento tuvieron cifras de presión arterial ≥ 130/85 mmHg. El 100 por ciento de los pacientes desconocían su enfermedad. Conclusiones: Se encontró predominio en los pacientes con síndrome metabólico del sexo femenino y del grupo de edad de 70 y más años. El diagnóstico a nivel de la Atención Primaria de Salud es deficiente. Se asocia a la hipertensión arterial, obesidad abdominal y al riesgo de enfermedad cardiovascular(AU)

Introduction: Metabolic syndrome is a complex clinical situation associated with an increase in morbidity and mortality. The elements that mark it up increase the risk of type 2 diabetes mellitus and cardiovascular disease. Objective: To determine the behavior of metabolic syndrome in elderly adults involved in the community physical activity programs of the Lindo Amanecer project in the municipality of Arroyo Naranjo. Methods: A cross-sectional descriptive observational study was carried out. The study universe was made up of 120 elderly adults, 106 of which were interviewed in the period from April to October 2018. The Adult Treatment Panel III criteria for the diagnosis of metabolic syndrome were followed. The descriptive variables were expressed in percentages and, for the comparison of variables under study, the chi-square statistical method was used. Results: The obtained results showed 41.51percent of people with metabolic syndrome, with a predominance of people aged 70 years and older (54.54percent) and the female sex (93.18percent). One hundred percent had blood pressure values over or equal to 130/85 mmHg. One hundred percent of the patients did not have any knowledge of their disease. Conclusions: In patients with metabolic syndrome, the predominance corresponded to the female sex, as well as the age group of 70 years and older. Diagnosis at the primary healthcare level is deficient. It is associated with arterial hypertension, abdominal obesity and the risk of cardiovascular disease(AU)

A novel heterozygous missense mutation of Trp1220Gly in the insulin receptor gene associates with type A insulin resistance syndrome: A case report / 中华内分泌代谢杂志

We report a case of type A insulin resistance syndrome. A 16-year-old girl with BMI of 19.1 kg/m 2 presented with primary amenorrhea and hyperglycemia for two years. Baseline HbA 1C was 10.8%, along with severe hyperinsulinemia, increased total testosterone and free androgen index(FAI). Ultrasonography showed polycystic ovaries. Next generation sequencing identified a novel and de novo heterozygous missense mutation of Trp1220Gly in the insulin receptor gene. Short-term intensive insulin pump treatment was initiated, followed by insulin glargine, pioglitazone and acarbose combination regiment. Fasting blood glucose and insulin levels decreased significantly, but post-load hyperglycemia and hyperinsulinemia remained unsatisfactory. HbA 1C dropped to 7.6% at 1-year follow up. Patients with polycystic ovarian syndrome who are adolescent-onset and with lean body type should be taken into account of type A insulin resistance syndrome. Currently, there is no standardized treatment protocol, and therapy should be individualized based on the specific gene mutation of each patient.

Síndrome Metabólico en tres casas de abuelos del Municipio Boyeros. La Habana. 2016-2017 / Metabolic Syndrome in three elderly homes in Boyeros Municipality. Havana. 2016-2017

RESUMEN Introducción: El Síndrome Metabólico triplica el riesgo de desarrollar enfermedad cardiovascular. Se asocia a la obesidad y a estilos de vida poco saludables. Constituye uno de los principales factores de riesgo aterogénico por lo que es imprescindible su diagnóstico precoz a nivel de la atención primaria de salud. Objetivo: Determinar el comportamiento del Síndrome Metabólico en personas mayores de 60 años de las tres casas de abuelos del municipio Boyeros. Material y Métodos: Se realizó un estudio observacional descriptivo de corte transversal. El universo de estudio lo constituyeron 130 personas, de ellas se entrevistaron a 103 de las personas en el período de enero de 2016 a febrero de 2017. Se siguieron los criterios del Adult Treatment Panel III para el diagnóstico de Síndrome Metabólico. Las variables descriptivas se expresaron en por cientos y para la comparación de variables en estudio se utilizó el método estadístico de chi cuadrado. Resultados: Los resultados obtenidos mostraron 33,01 por ciento de pacientes con Síndrome Metabólico, predominó el grupo de edad de 60 a 64 años con 44,12 por ciento y el sexo femenino con 64,71 por ciento. El 97,06 por ciento tienen cifras de presión arterial ≥ 130/85 mmHg. El 100 por ciento de los pacientes desconocían su enfermedad. Conclusiones: Se encontró predominio en los pacientes con Síndrome Metabólico del sexo femenino y del grupo de edad de 60 a 64 años. El diagnóstico a nivel de la Atención Primaria de Salud es deficiente. Se asocia a la obesidad abdominal y al riesgo de enfermedad cardiovascular(A)

ABSTRACT Introduction: Metabolic Syndrome triples the risk of developing cardiovascular disease. It is associated with obesity and unhealthy lifestyles. This syndrome is one of the main atherogenic risk factors; consequently, its early diagnosis at the primary health care level is essential. Objective: To deterine the manifestations of the Metabolic Syndrome in people over 60 years of age in three elderly homes in Boyeros Municipality. Material and Methods: A descriptive observational cross-sectional study was carried out. The study universe consisted of 130 people, 103 of whom were interviewed during the period between January 2016 and February 2017.The criteria of the Adult Treatment Panel III were followed for the diagnosis of Metabolic Syndrome. Descriptive variables were expressed in percentages and the chi-square statistic was used to compare the study variables. Results: The results obtained showed that 33.01 percent of patients were suffering from Metabolic Syndrome, predominating the people aged 60 to 64 years (44.12 percent) and the female sex (64.71 percent). Furthermore, 97.06 percent presented blood pressures ≥130/85 mmHg and 100 percent of patients had no knowledge of their disease. Conclusions: Metabolic Syndrome predominated in female patients and in those aged 60 to 64 years. The early diagnosis at the primary health care level is poor. This syndrome is associated with abdominal obesity and the risk of cardiovascular disease(AU)

Type B insulin resistance syndrome: a systematic review

ABSTRACT A literature review on the clinical, laboratory, and treatment features of type B insulin resistance syndrome (TBIRS). Data from PubMed, the Virtual Health Library and Cochrane database were selected and analyzed using the REDCap application and R statistical program. From 182 papers, 65 were selected, which assessed 119 clinical cases, 76.5% in females and 42.9% in African-Americans, with an average age of 44 years. A common feature of TBIRS is co-occurrence of autoimmune diseases, such as systemic lupus erythematosus (most frequently reported). Hyperglycemia of difficult control was the mostly reported condition. Tests for anti-insulin receptor antibodies were positive in 44.2% of the cases. Disease management comprised fractional diet, insulin therapy (maximum dose given was 57 600 IU/day), plasmapheresis and immunosuppression with several classes of drugs, mainly glucocorticoids. Remission occurred in 69.7% of cases, in 30.3% of these spontaneously. The mortality rate was 15.38%. There was an inverse relationship between anti-insulin antibodies and remission (p = 0.033); and a positive correlation between combined immunosuppressive therapy and remission (p = 0.002). Relapse occurred in 7.6% of the cases. This rare syndrome has difficult-to-control diabetes, even with high doses of insulin, and it is usually associated with autoimmune diseases. Therapeutic advances using immunomodulatory therapy have led to significant improvements in the rate of remission.

Systemic lupus erythematosus complicated with autoimmune hypoglycemia with pancytopenia as first manifestation: A case report and literature review / 吉林大学学报(医学版)

Objetive: To analyze the hematological changes of systemic lupus erythematosus (SLE) and the clinical characteristics of immune-related hypoglycemia, and to provide the basis for the diagnosis and treatment of SLE complicated with autoimmune hypoglycemia (AIH). Methods: The clinical data a patient with SLE complicated with AIH with pancytopenia as the first manifestation were collected and the relevant literatures were reviewed. Results: A 70-year-old man was admitted to hospital because of dizziness and fatigue, and suffered from more than 3 months, aggravated for 2 weeks. The physical examination results showed pale conjunctiva, moist rales over the both lower lung and there were no other obvious positive signs. The blood test showed pancytopenia and the fasting blood glucose 2. 34 mmol · L-1 The pathomorphology of tissue was observed by bone marrow puncture; rheumatism examinations, glucose metabolism indexes, insulin autoantibodies (IAA) and other assistant examinations were performed, and the patient received the related treatment. The patient had a history of photosensitivity. Admission examinations indicated multiple serous effusions, urinary protein >). 5 g · 24 h-1, pancytopenia, abnormal antinuclear antibody (ANA) titer, pancreatic CT (-), and the patient was diagnosed as SLE complicated AIH finally. After treatment of prednisone, the symptoms of the patient were improved; the the whole blood count and fasting blood glucose responded well to the therapy of prednisone. After discharge from the hospital, the patient was treated with prednisone continuously and was required to regularly monitor the blood test and the blood glucose level. The patient's whole blood count was gradually increased and no hypoglycemia occurred. Conclusion: SLE with hematological changes as the first manifestation is easily misdiagnosed. And autoantibody-mediated glucose homeostasis should be considered when SLE is complicated with hypoglycemia.

Clinical Case Analysis of Clinical Pharmacists Participating in the Treatment of an Elderly Patient with Type B Insulin Resistance Syndrome / 中国药师

Type B insulin resistance syndrome (TBIRS) is known as a rare autoimmune disease which usually presents with con-tinuous hyperglycemia under large amount of insulin. This article described and analyzed the medical treatment of an elderly patient with TBIRS participated by clinical pharmacists. In the whole process of treatment,clinical pharmacists helped physicians establish an individual treatment scheme according to the patient's basic situation,characteristics of blood glucose,pathophysiology and concomitant diseases. On the basis of proper anti-hyperglycemic scheme,clinical pharmacists suggested that the patient be treated with glucocorti-coids and immunoregulators,and then thorough pharmaceutical care was provided for the patient. Finally, the patient's insulin dose decreased and blood glucose was better than that before the admission,which indicated the effect of medical treatment and the value of clinical pharmacists.

Lipid metabolism and mechanism research of piperine on glucose metabolism of model rats with insulin resistance syndrome / 中国药理学通报

Aim To investigate the effect of piperine (PIP)on triglycerides(TG),free fatty acid(FFA), tumor necrosis factor-α(TNF-α)and leptin of model rats with insulin resistance syndrome(IRS).Methods By feeding rats with high-fat,high-glucose and high-salt diet,IRS model rats were established.Triglycer-ides(TG)was observed dynamically every 4 weeks, treating on the 4th weeks and 8 weeks continuously. TG (method of GOD-POD),FFA (method of colori-metric),TNF-αand leptin (method of ELISA)were measured.Results After 8 weeks treatment,the level of TG,FFA,TNF-αand leptin in PIP group decreased obviously,while it increased in model group signifi-cantly.Conclusions PIP could reduce TG and FFA and improve abnormal lipid metabolism of model rats with IRS significantly.Perhaps the mechanism is relat-ed with the down-regulation of cytokine TNF-αand leptin.

Factores de riesgo para el desarrollo del síndrome de resistencia a la insulina en el trasplante renal / Risk factors for development of insulin-resistance syndrome in the renal transplant

Introducción: el síndrome de resistencia a la insulina es una complicación frecuente en el trasplante renal, derivado de múltiples factores. Objetivo: conocer cuáles alteraciones vinculadas al trasplante renal y su tratamiento constituyen factores de riesgo para la aparición del síndrome de resistencia a la insulina. Métodos: se realizó un estudio de casos y controles en 81 pacientes con trasplante renal, supervivencia del injerto mayor de 1 año y que no fueran diabéticos antes del implante. Se conformaron 2 grupos, uno de enfermos con el síndrome, n=39, según los criterios del ATPIII y otro control, n=42. Para detectar factores de riesgo se compararon: variables pretrasplante (edad del receptor, tiempo en diálisis, cifras de glucemia, colesterol y triglicéridos, índice de masa corporal, infección por el virus de la hepatitis C, antecedentes familiares de diabetes) y variables postrasplante (tratamiento inmunosupresor, dosis de esteroides al tercer mes del trasplante, niveles de ciclosporina A y presencia o no de rechazo). Las variables pretrasplante fueron categorizadas de forma conveniente para análisis univariado y multivariado en el que resultaron estadísticamente significativas, en el estudio univariado: el mayor tiempo en diálisis, la mayor edad del receptor, las cifras elevadas de glucemia pretrasplante, la positividad al virus C, el índice de masa corporal superior a 25 y los antecedentes familiares de diabetes, este último factor fue el único con representatividad estadística en el análisis multivariado. Al analizar las variables vinculadas al tratamiento inmunosupresor solo hallamos que los pacientes con el síndrome tenían valores medios de ciclosporinemia mayores, estadísticamente, que aquellos que no desarrollaron la complicación...

Introduction: the insulin-resistance syndrome (IRS) is a frequent complication in the renal transplantation due to multiple factors. Objective: to know which alterations linked to renal transplantation and its treatment are risk factors for appearance of insulin-resistance syndrome. Methods: a case-control study was conducted in 81 patients underwent renal transplantation, with a graft survival higher than 1 year and not to be diabetics before implant. Two groups were established, one including patients with this syndrome (n=39) according to the ATP-III criteria and another as control (n=42). To detect the risk factors pre-transplantation the following variables were compared: age or receptor, time in dialysis, glycemia figures, cholesterol and triglycerides, body mass index (BMI), infection for hepatitis C and a family history of diabetes and post-transplantation variables included immunosuppressive treatment, dose of steroids at third month post-transplantation, cyclosporine A levels and presence or not of rejection. The pre-transplantation variables were categorized in a suitable way for univariate and multivariate analysis where they were statistically significant, in the univariate study: the largest time in dialysis, the great age of recipient, the high figures of pre-transplantation glycemia, the positive to Virus C, body mass index higher than 25 and family history of diabetes, this latter factor was the only with statistic representativeness in multivariate analysis. Analyzing the variables linked to immunosuppressive treatment, only we note that patients with this syndrome had statistically mean values of cyclosporine higher than those without this complication...

A Case of the Type B Insulin Resistance Syndrome with Chronic Hepatitis B

Type B insulin resistance syndrome is rare autoimmune disease that is characterized by various abnormalities of glycemic homeostasis, from hyperglycemia caused by extreme insulin resistance to fasting hypoglycemia. It can combine with other autoimmune diseases, most commonly systemic lupus erythematosus. It usually occurs in women and accompanies acanthosis nigricans, hyperandrogenism, and, in many cases, ovary dysfunction. The diagnosis of type B insulin resistance syndrome is based largely on the presence of insulin receptor autoantibodies and hyperglycemia, or hypoglycemia and hyperinsulinemia. In some cases, patients with the type B insulin resistance have been successfully treated with immunosuppressive therapy and plasmapheresis. We experienced type B insulin resistance syndrome in a patient with chronic hepatitis B and used only plasmapheresis for treatment. The immunosuppressive therapy was omitted due to the state of activation of chronic hepatitis B. We present this case with a review of relevant literature.

The changes of insulin secretion in type A insulin resistance syndrome: a 7-year follow up / 中华内科杂志

Objective A previously reported female diagnosed with type A insulin resistance syndrome bearing a heterozygous missense mutation of R1174W in the insulin receptor gene was followed for 7 years since the age of 16 years. Methods Five-hour oral glucose tolerance tests (OGTT) were done on baseline, the 3rd, 6th and 7th year respectively, with serum insulin and C-peptide measured at the same time points. Areas under of curve (AUC) of glucose, insulin and C-peptide were compared between the years.Acute insulin response (AIR) was determined at baseline and the 7th year. The dose response were insulin secretion rates at each time point during OGTT being plotted over the corresponding glucose levels, and the slopes of which quantified the insulin secretion responding to glucose. Results The follow up data showed that the glucose metabolism of the subject did not deteriorate over time with yearly glycosylated hemoglobin A1c (HbAlc) being normal (4.6%-5.5%), and hyperinsulinemic hypoglycemia was a persistent phenomenon observed at 4-5 hours post-load. The fasting and AUCs of serum insulin and C-peptide tended to decline without simultaneously increase of those of plasma glucose. The AIR decreased by 56% as compared to baseline. The dose response curves shifted downward as years went by. Conclusions It supports that with the alleviation of physiological insulin resistance after puberty, the gross hyperinsulinemia tends to ameliorate, and β-cell secretion does not deteriorate over time as glucose homeostasis maintains.

Síndrome metabólico: ¿Qué debemos conocer del síndrome metabólico en nuestra práctica diaria? / Metabolic syndrome: What should we know about metabolic syndrome in our daily practice? / Síndrome metabólico: O que sabemos do síndrome metabólico em nossa prática diária?

El síndrome metabólico (SM) o de resistencia a la insulina es una entidad patológica que ha acaparado la atención de gran cantidad de científicos de diversas especialidades en las últimas dos décadas. Este cuadro caracterizado por una constelación de factores de riesgo para enfermedad cardiovascular y para el desarrollo de diabetes mellitus tipo dos tiene una gran prevalencia en todo el mundo y la misma va en aumento. El SM ha generado gran cantidad de controversias en relación a su clasificación, punto de corte de las variables que lo componen, fisiopatología y prevalencia en distintas poblaciones, las cuales aún hoy persisten. Esta sintética revisión pretende acercar al médico práctico el conocimiento imprescindible de un cuadro clínico de gran importancia epidemiológica e individual para ayudar a nuestros pacientes a salir del círculo vicioso que representa el SM, puesto que si esto no ocurre nuestros pacientes resultarán tarde o temprano en severas complicaciones que comprometerán su calidad y cantidad de vida.

Metabolic syndrome (MS) or insulin resistance syndrome is a pathological entity that has caught the attention of many scientists from different specialties within the last two decades. This clinical setting, which is characterized by a constellation of risk factors for cardiovascular disease and the development of diabetes mellitus type two, has a high prevalence worldwide and it is growing. The MS has generated lots of controversy regarding its classification, cutoff point of its variables, physiopathology and prevalence in different populations, which still persist today. This synthetic review aims to bring essential knowledge to practitioners about a clinical setting with a great epidemiological and individual importance, in order to assist our patients to break the vicious circle that represents the MS, because if this does not happen, our patients sooner or later result in severe complications that compromise their quality and quantity of life.

O síndrome metabólico (SM) ou resistência à  insulina é uma entidade patológica que tem captado a atenção de muitos cientistas de diferentes especialidades nas últimas duas décadas. Este quadro é caracterizado por uma constelação de fatores de risco para doenà§a cardiovascular e ao desenvolvimento de diabetes mellitus tipo dois têm uma elevada prevalência em todo o mundo e está crescendo. O SM tem gerado muita controvérsia quanto à  sua classificação, o ponto de corte de suas variáveis, fisiopatologia e prevalência em diferentes populações, que persistem até hoje. Esta revisão sintética visa trazer o conhecimento essencial para os profissionais, sobre um quadro clínico com uma grande importà¢ncia epidemiológica e individual, a fim de ajudar os nossos pacientes para quebrar o círculo vicioso que representa o SM, pois, se isso não acontecer, os nossos pacientes, mais cedo ou mais tarde, resultar em complicações graves que comprometem sua qualidade e quantidade de vida.

Síndrome de resistencia a la insulina después del trasplante renal / Insulin resistance syndrome after renal transplantation

El síndrome de resistencia a la insulina (SRI) es una complicación frecuente y multifactorial vinculada a una evolución poco satisfactoria del injerto renal y del paciente. Se realizó un estudio de casos y controles con 81 pacientes con más de 1 año de trasplante y sin diagnóstico de diabetes mellitus antes del mismo, los casos fueron pacientes con diagnóstico de SRI por al menos 1 de 3 criterios utilizados (NCEP-ATP-III, OMS y FID) y los controles los que no presentaron esta complicación. Determinar frecuencia de SRI, antes y después del trasplante renal, criterios útiles para diagnóstico e impacto sobre la función del injerto, fueron los objetivos de este estudio. Se obtuvo 48,1 por ciento de pacientes con SRI, 18 (22,2 por ciento) desde la etapa pretrasplante y 21 (25,9 por ciento) lo desarrollaron de novo. Según los criterios de la ATP-III y de la FID, se diagnosticaron 31 pacientes (79,4 por ciento), mientras que por el de la OMS sólo se diagnosticó el 41 por ciento, los componentes del síndrome con mayor presencia en la muestra de estudio fueron: hipertensión arterial, hipertrigliceridemia y obesidad abdominal en orden decreciente, lo cual justifica los resultados al aplicar los diferentes criterios diagnósticos. Al comparar intensidad de filtración glomerular y valores de creatinina plasmática según la presencia o no de SRI, los enfermos con SRI presentaron mayor deterioro de la función del injerto aunque no estadísticamente significativo

Insulin resistance syndrome (IRS) is a common multifactorial complication associated with unsatisfactory evolution of the renal graft and the patient. We conducted a case-control study of 81 patients with more than 1 year of transplantation and without a diagnosis of diabetes mellitus before it. The cases were patients with IRS by at least 1 of the 3 criteria used (NCEP-ATP-III, WHO and IDF) and the controls were those who did not present this complication. The objective of the study was to determine the frequency before and after renal transplantation, useful criteria for the diagnosis and impact on graft function. We obtained 48.1 percent of patients with IRS, of whom 18 (22.2 percent) had it from the stage before transplantation and 21 (25.9 percent) developed it de novo. ATP III and IDF criteria diagnosed 31 patients (79.4 percent), while the WHO criterion diagnosed only 41 percent. The components of the syndrome with greater presence in the study sample were: high blood pressure, hypertriglyceridemia and abdominal obesity in descending order, which justifies the results obtained when applying the different diagnostic criteria. On comparing the intensity of glomerular filtration and plasma creatinine values according to the presence of IRS, it was found that IRS patients presented greater deterioration of graft function, though it was not statistically significant

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.

Insulin Resistance and Insulin Resistance Syndrome / 한양의대학술지

Insulin resistance is the main pathophysiologic abnormality of type 2 diabetes mellitus. Insulin resistance and resultant compensatory hyperinsulinemia are closely associated with other important cardiovascular risk factors such as hypertension, dyslipidemia and artherosclerosis. Genetic factors and environmental factors such as obesity and physical inactivity contribute to the development of insulin resistance. Recently mitochondrial dysfunction, ER (endoplasmic Reticulum) stress and inflammation has been known to be linked with insulin resistance. At present, lifestyle modification and metformin and thiazolidinediones are known to reduce insulin resistance with some limitations. Considering both clinical importance of insulin resistance and rapid advances in our understanding of pathogenesis of insulin resistance, new therapeutic strategies based on novel molecular mechanisms of insulin resistance are anticipated

Incidence and Risk Factors of Insulin Resistance Syndrome in 20-59 Year-Old Korean Male Workers

We investigated the incidence of insulin resistance syndrome (IRS) according to the criteria of diagnoses suggested by the American College of Endocrinology/ American Association of Clinical Endocrinologists and the risk factors associated with the development of IRS. Among 2,048 subjects without a history of/or drug treatment for hypertension, diabetes, dyslipidemia with normal findings at baseline, 1,578 subjects aged 20-59 yr were followed prospectively for 2 yr. The incidence of IRS was 6.9 per 100 persons/year. The relative risk (RR) due to age was 1.03 (95% CI: 1.00-1.05) with every one-year increase in age. The RR associated with an abnormal waist-hip ratio group (> or =0.9) was increased by 1.74 (95% CI: 1.17-2.58) compared to the normal group ( or =35 IU/L) by 1.70 (95% CI: 1.20-2.41) compared to the normal group ( or =160 mg/L) by 1.70 (95% CI: 1.19-2.44) compared to the normal LDL cholesterol (<160 mg/L). Lastly, the RR of current smokers was increased by 1.63 (95% CI: 1.09-2.42) compared to that of non-smokers. It is necessary to develop methods of prevention and therapeutic approach to manage the integrated risk factors as opposed to individual factors.

Serum Ferritin as a Risk Factor in Type 2 Diabetes Mellitus / 소아과

PURPOSE: Iron accumulation interferes with hepatic insulin extraction and affects insulin synthesis and secretion. The purpose of this study is to investigate the correlation between serum ferritin and type 2 diabetes mellitus. METHODS: We compared the serum ferritin level among 18 patients in an impaired glucose tolerance (IGT) group, 36 in a type 1 diabetes group, eight in a type 2 diabetes group and 29 in a healthy control group. The correlation between serum ferritin levels and sex, body mass indices (BMI), blood pressure (BP), serum fasting sugar level and serum fasting insulin level were also analyzed. RESULTS: The mean log ferritin were 1.33+/-0.32 (healthy control group), 1.63+/-0.19 (IGT group) and 1.90+/-0.30 (type 2 diabetes group). In the IGT group, log ferritin was higher than in the healthy control group (P=0.001). The log ferritin of the type 2 diabetes group was higher than that of the healthy control group (P=0.001). Comparing log ferritin to other factors, log ferritin had a significant positive correlation with body mass indices (P< 0.001), systolic blood pressure (P=0.001), and fasting glucose (P= 0.001), fasting insulin (P=0.002). CONCLUSION: Compared to the normal healthy group, serum ferritin concentrations were significantly higher in the IGT group and the type 2 diabetes group. The elevation of serum ferritin concentration may be a risk factor of type 2 diabetes mellitus.

The Relationship between Dehydroepiandrosterone sulfate and Insulin Resistance Syndrome in Women / 대한내분비학회지

BACKGROUND: Dehydroepiandrosterone (DHEA) is an androgen precursor, and is known to be decreased by the aging process. DHEA has been known to have a protective effect on insulin resistance and cardiovascular disease in men, but remains controversial in women. The aim of this study was to elucidate the role of DHEA on insulin resistance, and the risk for cardiovascular disease, in women. METHODS: We analyzed the relationship between DHEA sulfate (DHEAS), known to have a longer half-life and less diurnal variation than DHEA, and insulin resistance syndrome (IRS) in 471 non-diabetic women from an urban community diabetes prevalence study. Serum DHEAS concentrations were measured using a commercially available radioimmunoassay kit. RESULTS: 1. The frequencies of obesity, impaired glucose tolerance, hypertension and dyslipidemia were 25.3, 8.5, 21.9 and 6.2%, respectively, and the frequency of IRS was 16.5%. 2. DHEAS was significantly inversely correlated with age (r=-0.47, p<0.001), systolic blood pressure (r=-0.18, p<0.001), diastolic blood pressure (r=-0.10, p<0.05), fasting serum glucose (r=-0.10, p<0.05), postchallenge 2 hour glucose (r=-0.12, p<0.01) and triglycerides (r=-0.16, p<0.01). 3. As serum DHEAS concentrations, by quartiles, were decreased, the age-adjusted frequency of hypertension was significantly increased (p<0.05). 4. A Multiple linear regression analysis revealed that DHEAS was significantly associated with age (p<0.0001) and BMI (p<0.05). 5. A Logistic regression analysis showed that DHEAS was not associated with IRS after adjustment for age. CONCLUSION: DHEAS is inversely associated with age. DHEAS has no harmful effect, and may even have a protective role, on insulin resistance syndrome. Prospective examinations of DHEAS and insulin resistance syndrome in women are needed to confirm the mechanism for the association between DHEAS and the development of cardiovascular disease.

Patterns of Insulin Resistance Syndrome in the Taegu Community for the Development of Nutritional Service Improvement Programs / 대한지역사회영양학회지

The clustering of insulin resistance with hypertension, glucose intolerance, hyperinsulinemia, increased triglyceride and decreased HDL cholesterol levels, and central and overall obesity has been called syndrome X, or the insulin resistance syndrome(IRS). To develop a nutrition service for IRS, this study was performed to evaluate the prevalence of each component of the metabolic abnormalities of IRS and analyze the clustering pattern of IRS among subjects living in the Taegu community. Participants in this study were 9234(mean age ; M/F 48/40yrs);63.5% were men, 24.4% were obese, 13.3% had hypertension. 3.7% had hyperglycemia, and 32.4% had hyperlipidemia. The IRS was defined as the coexistence of two or more components among metabolic abnormalities; obesity, hypertension. hyperglucemia and hyperlipidemia. The prevalence of IRS in Taegu was 19.2%(M/F:20.8%/16.4%), the clustering of these fisk variables was higher in advanced age group. Among the subjects of IRS having two of more diseases, 75.6% were obese, the pattern were similar in men and women. The younger, the higher the prevalence of obesity associated clustering patterns. The prevalence of obesity associated patterns among the hyperglycemia associated clustering patterns was 44.5%. The samples of the representative clustering patterns were obesity and hyperlipidemia (8.0%), hypertension and hyperlipidemia(3.2%), hypertension, obesity and hyperlipiemia(3.1%), hypertension and obesity(2.3%), and hyperglycemia and hyperlipidemia(0.8%). The clustering of obesity and hyperlipidemia until 50 year old groups, and the clustering of hypertension and hyperlipidemia in the 60 and 70 age groups were the most prevalent. We concluded that insulin resistance syndrome was a relatively common disorder in the Taegu community, and prevalence and the characteristics of the intervention strategies for IRS are desired, an effective improvement will be achieved.

Comparison of Lifestyle and Nutrient Intake by Number of Components of Insulin Resistance Syndrome in the Daegu Community / 대한지역사회영양학회지

The purpose of this study was to figure out the characteristics of dietary habits and lifestyles related to the development of insulin resistance syndrome(IRS). The participants in this study were 595 adults with one or more abnormal data from a health examination and 215 normal adults. When IRS was defined as a condition in which the subjects have 2 or more abnormalities among obesity, hyperlipidemia, hypertension and hyperglycemia, the prevalence rate was 37.8%. We classified the 595 adults by the number of components of IRS components they had, the higher age and obesity index they had. Total cholesterol and glucose levels in the blood were also positively related to the number of IRS components. IRS subjects tended to practice less habitual drinking and more exercise and weight control. Coffee consumption and dining out frequency were also lower in the IRS group. An analysis of food habits by odds ratio indicated that total food score was better in the IRS group. However, it appeared that food habits such as \"frequent snacking\" and \"never rejecting offered foods\" need to be improved in IRS subjects. Other undesirable food habits were related to the consumption of eggs, dairy products, fried foods, garlic and onion. Dietary intake of Ca, Fe, riboflavin, Vit A, and energy were less than 75% of the Korean recommended allowance for more than half of the subjects. Nutrient intake was lower, Ca/P ratio from food intake was worse in the IRS group. Our results indicated that nutrition counseling for IRS need to be focused on balanced food intake to supply sufficient amount of each nutrient.

Microalbuminuria in Cushings syndrome: remission after correction of hypercortisolemia / 대한내과학회지

OBJECTIVES: Microalbuminuria predicts cardiovascular mortality in patients with non-insulin-dependent diabetses mellitus (NIDDM). Microalbuminuria is frequently associated with high blood pressure, dyslipidemia, insulin resistance and central obesity, and has been suggested to be a feature of metabolic syndrome (syndrome X). Metabolic syndrome is also present in Cushings syndrome, which is characterized by primary hypercortisolism as well as profound visceral obesity. Considering common features of Cushings syndrome and metabolic syndrome, microalbuminuria could be a feature of Cushings syndrome. METHODS: We studied urinary albumin excretion (UAE) in 13 patients with Cushings syndrome. UAE was reexamined after the correction of hypercortisolemia in the patients with microalbuminuria or overt proteinuria. Kidney biopsy was performed in 3 patients with microalbuminuria. RESULTS: Eight out of 13 patients (61.5 %) had microalbuminuria. Kidney biopsy revealed apparently normal glomerular structures without evidence of diabetic or hypertensive nephropathy. Patients underwent successful removal of pituitary or adrenal tumors and were reevaluated 2 months after surgery. UAE declined profoundly in all of the patients with initial microalbuminuria. CONCLUSION: Our results demonstrate that more than 60% of patients with Cushings syndrome have microalbuminuria. This rate far exceeds the rate in NIDDM patients and hypertensive patients. Microalbuminuria nearly completely reversed after successful treatment of hypercortisolism.