Prevalence of metabolic syndrome and its association with lifestyle and cardiovascular biomarkers among postmenopausal women in western Algeria.

OBJECTIVE: To evaluate the prevalence of metabolic syndrome (MetS), its components, and their relationship with lifestyle, inflammation, and oxidative stress among postmenopausal Algerian women. METHODS: A prospective cross-sectional survey was conducted among postmenopausal women at a clinic in Oran, Algeria, from March 1 to June 28, 2015. A diagnosis of MetS was made using the National Cholesterol Education Program Adult Treatment Panel III guidelines. Demographic, clinical, metabolic, inflammatory, dietary, and energy variables were assessed. RESULTS: Among 183 participants, 106 (57.9%) were diagnosed with MetS. Components of MetS included hypertension (n=144, 78.7%), hyperglycemia (n=135, 73.8%), hypertriglyceridemia (n=125, 68.3%), abdominal obesity (n=123, 67.2%), and low levels of high-density lipoprotein cholesterol (n=121, 66.1%). Although daily energy expenditure was similar among the women with or without MetS, total energy intake was increased in the group with MetS (P<0.001). The following measures were also increased among women with MetS: saturated fatty acid intake (P<0.001), C-reactive protein (P=0.051), thiobarbituric acid reactive substances (P<0.001), and carbonyls (P<0.001). By contrast, decreased monounsaturated fatty acid intake (P=0.024) and catalase activity (P<0.001) were observed in this group. CONCLUSION: Postmenopausal status could predict MetS, with inflammation and oxidative stress arising from an unhealthy lifestyle potentially increasing cardiovascular risk.

Blood pressure, dyslipidemia and inflammatory factors are related to body mass index in scholar adolescents.

INTRODUCTION: Obesity is associated with increased occurrence of numerous diseases, including hypertension, dyslipidemia, insulin resistance, diabetes, and atherosclerosis. Blood pressure (BP), dyslipidemia, and inflammation markers and their relationships with body mass index (BMI) were determined in scholar adolescents. MATERIAL AND METHODS: Adolescents (n = 210) (sex ratio G/B = 106/104; 11 to 16 years) were recruited in three colleges of Oran city. Anthropometric parameters were measured to classify adolescents as thin (T), normal weight (NW), overweight (OW), or obese (O). Waist circumference (WC) and BP were measured, and serum glucose, uric acid, urea, lipid parameters, tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6), C-reactive protein (CRP), insulin, leptin, and adiponectin were analyzed. RESULTS: Adolescents were classified according to their BMI as T (15%), NW (63%), OW (13%), and O (9%). Compared to NW, increased values of WC, BP (p < 0.001), and glucose (p < 0.01) were noted in OW and O groups. Total cholesterol (TC) level was elevated in O adolescents (p < 0.01). Increased low-density lipoprotein cholesterol (LDL-C) in OW (p < 0.05) and O (p < 0.01), and reduced high-density lipoprotein cholesterol (HDL-C) concentrations were noted in both OW and O groups (p < 0.05), compared to NW. Elevated triglyceride (TG) values and TG : HDL-C ratio were observed in OW (p < 0.05) and O (p < 0.01). High values of uric acid were noted in OW and O adolescents (p < 0.01). Compared to NW, there was no significant difference in IL-1ß whereas IL-6 was elevated in T (p < 0.05), OW (p < 0.01) and O (p < 0.001). Leptin, TNF-α, and CRP concentrations were significantly increased (p < 0.001), whereas adiponectin values were decreased in both OW and O groups (p < 0.01), compared to NW. CONCLUSIONS: Significant associations were noted between WC, BP, dyslipidemia, inflammation markers, and BMI, indicating that both OW and O adolescents have a tendency to present metabolic syndrome risk factors.

Lipid profile, inflammation, and oxidative status in peri- and postmenopausal women.

OBJECTIVE: To evaluate the effect of perimenopause and postmenopause on lipid profile, inflammation, and oxidative stress in women. METHODS: This cross-sectional study included 117 women (47 ± 6 years) classified as perimenopausal (n = 47), postmenopausal (n = 40), or non-menopausal (n = 30). In serum, we analyzed lipid profile, tumor necrosis factor-alpha (TNF-α), interleukin-1α (IL-1α), and C-reactive protein (CRP). Pro-oxidant status was assessed by thiobarbituric acid reactive substances (TBARS) and protein carbonyls. Antioxidant defense was performed by analysis of superoxide dismutase (SOD) and catalase activities. RESULTS: Compared to non-menopausal women, triacylglycerols (TG) were similar, total cholesterol and LDL-C were higher in perimenopausal and postmenopausal women, while HDL-C concentrations were decreased. TNF-α and IL-1α were higher in postmenopausal women, while CRP concentrations were elevated in both peri-and postmenopausal women (p < 0.05). TBARS and carbonyls were increased in peri- and postmenopausal women (p < 0.05). SOD and CAT activities were decreased in postmenopausal women (p < 0.05) and elevated in perimenopausal women. CONCLUSION: Menopausal transition and postmenopause were associated with dyslipidemia, inflammation, and unbalanced oxidative status exposing women to cardiovascular risk.

Inflammatory status in chronic renal failure: The role of homocysteinemia and pro-inflammatory cytokines.

AIM: To evaluate determinants of inflammatory markers in chronic renal failure patients according to the level of glomerular filtration rate. METHODS: One hundred fifty four patients (Age: 44 ± 06 years; male/female: 66/88) with chronic renal failure (CRF) were divided into 6 groups according to the National Kidney Foundation (NKF) classification. They included 28 primary stage renal failure patients (CRF 1), 28 moderate stage renal failure patients (CRF 2), 28 severe stage renal failure patients (CRF 3), 18 end-stage renal failure patients (CRF 4), 40 hemodialysis (HD) patients, and 12 peritoneal dialysis (PD) patients. Tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6) and C-reactive protein (CRP) were analyzed by immunosorbent assay kit (ELISA) (Cayman Chemical's ACETM EIA kit). Immunoassay methods were used for total homocysteine (tHcy) (fluorescence polarization immunoanalysis HPLC, PerkinEmer 200 series), transferrin (MININEPHTM human transferin kit: ZK070.R), ferritin (ADVIA Centaur) and fibrinogen analysis (ACL 200). Differences between groups were performed using SPSS 20.0 and data are expressed as the mean ± SD. RESULTS: Results showed that in comparison with CRF 1 group and other groups, TNF-α and IL-6 levels were respectively more elevated in HD (16.38 ± 5.52 pg/mL vs 0.39 ± 0.03 pg/mL, 11.05 ± 3.59 pg/mL vs 8.20 ± 0.22 pg/mL, P < 0.001) and PD (14.04 ± 3.40 pg/mL vs 0.39 ± 0.03 pg/mL, 10.15 ± 1.66 pg/mL vs 8.20 ± 0.22 pg/mL, P < 0.001). IL-1ß levels were increased in HD (9.63 ± 3.50 pg/mL vs 3.24 ± 0.10 pg/mL, P < 0.001) and CRF 4 (7.76 ± 0.66 pg/mL vs 3.24 ± 0.10 pg/mL, P < 0.001) patients than in CRF 1 and in the other groups. Plasma tHcy levels were higher in HD (32.27 ± 12.08 µmol/L) and PD (28.37 ± 4.98 µmol/L) patients compared to the other groups of CRF (P < 0.001). The serum CRP level was significantly increased in HD (18.17 ± 6.38 mg/L) and PD (17.97 ± 4.85 mg/L) patients compared to the other groups of CRF patients (P < 0.001). The plasma fibrinogen level was more elevated in HD (6.86 ± 1.06 g/L) and CRF 4 (6.05 ± 0.57 g/L) than in the other groups (P < 0.001). Furthermore; the ferritin level was higher in HD (169.90 ± 62.16 ng/mL) and PD (90.08 ± 22.09 ng/mL) patients compared to the other groups of CRF (P < 0.001). The serum transferrin value was significantly decreased especially in PD (1.78 ± 0.21 g/L) compared to the other groups (P < 0.001). We found a negative correlation between glomerular filtration rate (GFR), TNF-α levels (r = -0.75, P < 0.001), and tHcy levels (r = -0.68, P < 0.001). We observed a positive correlation between GFR and transferrin levels (r = 0.60, P < 0.001). CONCLUSION: CRF was associated with elevated inflammatory markers. The inflammation was observed at the severe stage of CRF and increases with progression of renal failure.

Effect of different stages of chronic kidney disease and renal replacement therapies on oxidant-antioxidant balance in uremic patients.

Oxidative stress seems to be involved in the path physiology of cardiovascular complications of chronic kidney disease (CKD). In this study, we determined the effect of different stages of CKD and substitutive therapies on oxidative stress. One hundred sixty-seven patients (age: 44 ± 06 years; male/female: 76/91) with CKD were divided into 6 groups according to the National Kidney Foundation classification. Prooxidant status was assessed by assaying thiobarbituric acid reactive substances, hydroperoxides, and protein carbonyls. Antioxidant defence was performed by analysis of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, vitamin E, Iron, and bilirubin. TBARS and LPO were higher in HD patients compared to other groups (P < 0.001), while protein carbonyls were more increased in PD patients. The antioxidant enzymes were declined already at severe stage of CKD and they were declined notably in HD patients (P < 0.001). Similar observation was found for vitamin E, Fe, and bilirubin where we observed a significant decrease in the majority of study groups, especially in HD patients (P < 0.001). The evolution of CKD was associated with elevated OS. HD accentuates lipid, while PD aggravates protein oxidation. However, the activity of antioxidant enzymes was altered by impaired renal function and by both dialysis treatments.

Hemodialysis duration impairs food intake and nutritional parameters in chronic kidney disease patients.

INTRODUCTION: The aim of this study was to evaluate the effect of hemodialysis (HD) duration on food intake and nutritional markers in patients with chronic kidney disease (CKD). METHODS: Twenty CKD patients received maintenance HD over a 9-year period. At the beginning of the study (T0) and at 3-year intervals (T1, T2, and T3) during the 9-year follow-up, a nutritional survey using the 24-h recall and record method was repeated for 4 days, and the blood samples were drawn. The results from T0 were used as references. Nutritional status was assessed through food intake, nutritional markers (urea, uric acid, creatinine, cholesterol, total protein, and albumin), and anthropometric measurements (height, dry weight, and body mass index). RESULTS: HD duration was correlated with energy intake (r = -0.89, P < 0.01), protein intake (r = -0.50, P < 0.05), and body mass index (r = -0.50, P < 0.05). Albuminemia decreased over time. Reduced carbohydrate intakes were noted in patients at T1 (-8%), T2 (-38%), and T3 (-59%) with decreased fiber intakes. Lipid intake was diminished by 11, 17, and 25% in patients, respectively, at T1, T2, and T3. The consumption of milk and dairy products, meats, fish, eggs, fruits, vegetables, and fat was reduced at T1, T2, and T3. In conclusion, long-term HD fails to correct undernutrition caused by CKD. Long-term dialysis complications could be reduced with preventive measures, including the use of biocompatible membranes and high-dose dialysis. Consequently, patients could experience a decreased prevalence of protein-energy malnutrition.

Effect of hemodialysis and peritoneal dialysis on redox status in chronic renal failure patients: a comparative study.

OBJECTIVE: To investigate the effects of hemodialysis (HD) and periotoneal dialysis (PD) on oxidative stress in chronic renal failure patients (CRF). METHODS: 20 HD patients (M/F: 8/12, 36 ± 12 years) and 20 PD patients (M/F: 10/10, 40 ± 8 years) were compared with 20 end stage renal failure patients (CRF) (M/F: 4/16, 61 ± 13 years). RESULTS: Thiobarbituric acid reactive substances (TBARS) values were elevated in HD and decreased in PD compared to CRF (P < 0.05). TBARS-VLDL and TBARS-HDL2 were decreased in HD and PD, compared to CRF (p < 0.05). TBARS-LDL were higher in HD compared to CRF (p < 0.05). No significant difference in TBARS-HDL3 values between the three groups. Carbonyls were increased in HD (p < 0.05) and PD (p < 0.01) compared to CRF. Plasma superoxide dismutase activity (SOD) was decreased in HD compared to CRF and PD (P < 0.05). Glutathion peroxidase activity (GSH-Px) was decreased in HD and PD (P < 0.005), compared to CRF. Decrease in catalase activity was noted only in PD compared to CRF (P < 0.05). An increase in nitric oxide was noted in HD compared to CRF (p < 0.05). Albumin concentrations were higher in HD and PD compared to CRF (P < 0.001). Whereas uric acid concentrations were decreased in HD (P < 0.001) compared to CRF and PD. Bilirubin values were similar in all groups. Increased values of iron were noted in HD and PD, compared to PD (p < 0.001). CONCLUSION: HD and PD aggravate oxidative stress generated by uremia. HD accentuates lipid and protein peroxidation, while PD aggravates protein oxidation. However, the activity of antioxidant enzymes was altered by both dialysis treatments.

Effects of omega-3 polyunsaturated fatty-acid supplementation on redox status in chronic renal failure patients with dyslipidemia.

OBJECTIVE: We sought to evaluate the effects of omega-3 polyunsaturated fatty-acid (PUFA) supplementation on dyslipidemia, lipid and protein peroxidation, and antioxidant defense in patients with chronic renal failure (CRF). DESIGN: Eighty patients with CRF were diagnosed in the hospital of Oran between January 2008 and April 2008. Forty patients (male/female, 22/18; aged 61 +/- 14 years, S.D.) were available for the study. They presented with dyslipidemia and hypertriglyceridemia (triacylglycerols, >1.7 mmol/L) and/or hypercholesterolemia (total cholesterol, >5 mmol/L). INTERVENTION: All patients received nutritional counsel adapted to CRF, i.e., energy intake of .12 megajoule x kg(-1) x body weight x day(-1), protein intake of .8 g x kg(-1) x body weight x day(-1), and lipid intake of 35% of total energy intake with 28% PUFAs, 37% monounsaturated fatty acids, and 35% saturated fatty acids. Patients were randomized into two groups: 20 received supplementation with omega-3 fish oil (2.1 g . day(-1)) for 90 days, and 20 were used as controls. To control the counsel monitoring, a nutritional survey was performed at baseline and at 12 weeks. Blood samples were drawn at the beginning (T0), at 30 days (T1), at 60 days (T2), and at 90 days (T3) after initiating treatment. RESULTS: In the omega-3 group, a reduction in triacylglycerol levels was evident at T1 (-43%), T2, and T3 (-48%). Thiobarbituric acid-reactive substances were at lower levels at T1 and T3. There was no significant difference in carbonyl values, whereas serum superoxide dismutase and glutathione peroxidase activities were increased at T1, T2, and T3. High catalase activity was evident at T2 and T3. CONCLUSION: Omega-3 supplementation improves hypertriglyceridemia and oxidative stress in patients with CRF, and may lead to decreased rates of cardiovascular complications.

Mediterranean diet improves dyslipidemia and biomarkers in chronic renal failure patients.

Dyslipidemia, oxidative stress (OS) and inflammation increase the risk of cardiovascular disease in chronic renal failure (CRF) patients. The aim of this study was to evaluate the effect of nutritional advice on dyslipidemia and biomarkers in CRF patients. 40 CRF patients with dyslipidemia, hypertriglyceridemia and/or hypercholesterolemia were randomly assigned to either the control or the intervention group. The intervention group received nutritional advice adapted to a Mediterranean diet (MD). Patients were assessed at baseline (T0) and after 30 (T1), 60 (T2) and 90 (T3) days for dietary intake and biomarkers. In the intervention group compared to the control group, TG concentrations were decreased by 26% at T3 (p < 0.05), TC concentrations were diminished by 14% at T2 and by 35% at T3 (p < 0.05). A decrease in LDL-C was noted at T2 and T3 (p < 0.05). The TC/HDL-C ratio was diminished at T1, T2 and T3 (p < 0.05). The apo A-I/apo B ratio was elevated at T3 (p < 0.05). HDL-C, apo A-I, apo B concentrations and the TC/LDL-C ratio were similar in the both groups at T1, T2 and T3. Creatinine, urea, glomerular filtration rate (GFR), urate, iron and bilirubin values remained unchanged in both groups. Haemoglobin concentrations were elevated at T1 (p < 0.05). Increased albumin values were observed at T2 (p < 0.05). CRP concentrations were decreased by 29% at T1 (p < 0.05) and 40% (p < 0.01) at T3. Fibrinogen (p < 0.01) concentrations were decreased at T3. In the intervention group compared to control group (p < 0.01), TBARS values were decreased by 16% at T2 and 21% at T3 (p < 0.05). In this study, we demonstrate that the nutritional management of CRF patients before dialysis based on the MD improves food consumption, reduces dyslipidemia and protects against lipid peroxidation and inflammation, allowing patients to enter dialysis with an acceptable nutritional and cardiovascular state.

Long term hemodialysis aggravates lipolytic activity reduction and very low density, low density lipoproteins composition in chronic renal failure patients.

BACKGROUND: Dyslipidemia, particularly hypertriglyceridemia is common in uremia, and represents an independent risk factor for atherosclerosis. METHODS: To investigate the effects of hemodialysis (HD) duration on very low density lipoprotein (VLDL) and low density lipoprotein (LDL) compositions and lipopolytic activities, 20 patients on 5 to 7 years hemodialysis were followed-up during 9 years. Blood samples were drawn at T0 (beginning of the study), T1 (3 years after initiating study), T2 (6 years after initiating study) and T3 (9 years after initiating study). T0 was taken as reference. RESULTS: Triacylglycerols (TG) values were correlated with HD duration (r = 0.70, P < 0.05). An increase of total cholesterol was noted at T2 and T3. Lowered activity was observed for lipoprotein lipase (LPL) (-44%) at T3 and hepatic lipase (HL) (-29%) at T1, (-64%) at T2 and (-73%) at T3. Inverse relationships were found between HD duration and LPL activity (r = -0.63, P < 0.05), and HL activity (r = -0.71, P < 0.01). At T1, T2 and T3, high VLDL-amounts and VLDL-TG and decreased VLDL-phospholipids values were noted. Increased LDL-cholesteryl esters values were noted at T1 and T2 and in LDL-unesterified cholesterol at T2 and T3. CONCLUSION: Despite hemodialysis duration, VLDL-LDL metabolism alterations are aggravated submitting patients to a greater risk of atherosclerosis.

Effect of long-term hemodialysis on plasma lecithin: cholesterol acyltransferase activity and the amounts and compositions of HDL2 and HDL3 in hemodialysis-treated patients with chronic renal failure: a 9-year longitudinal study.

BACKGROUND: Atherosclerosis was correlated with hemodialysis duration (HD) in chronic renal failure (CRF) patients. Dyslipidemias were identified as atherogenic risk factors. MATERIAL/METHODS: To investigate variations in HDL2 and HDL3 composition and lecithin: cholesterol acyltransferase (LCAT) activity as functions of HD, 20 CRF patients were selected for maintenance hemodialysis during the 9 years from April 1, 1991 to March 31, 2000. Blood samples were drawn four times: 1991 (T0, study begin), 1994 (T1), 1997 (T2), and 2000 (T3). T0 results were taken as references. RESULTS: Triacylglycerol concentrations were 1.12-fold higher at T1 (P<0.01), 1.31-fold at T2, and 1.63-fold at T3 (P<0.001). Increases of 14% and 33% of total cholesterol were noted at T2 (P<0.05) and T3 (P<0.001). Hypertriglyceridemia correlated with HD (r=0.70, P<0.05). LCAT activity decreased by 27%, 39%, and 51% at times T1, T2, and T3, respectively, this activity being negligible in 30% of patients at T2 and 40% at T3. An inverse relationship was noted between LCAT activity and HD (r=-0.80, P<0.001). Increases in HDL2-unesterified cholesterol (UC) and HDL3-UC were obtained at T2 and T3 (P<0.05), and high HDL2-triacylglycerols (TG) and HDL3-TG were noted at T1, T2, and T3 (P<0.001). HDL3-phospholipids (PL) values were diminished by 9% at T1 (P<0.05), 17% at T2, and 19% at T3 (P<0.001). CONCLUSIONS: Long-term hemodialysis aggravates lipid anomalies following CRF. Alterations in HDL composition contribute to the reduced efficacy of reverse cholesterol transport and patients are submitted to a greater risk for atherosclerosis.

Plasma lipoprotein lipase, hepatic lipase activities, VLDL, LDL compositions at different times of hemodialysis.

The effects of hemodialysis duration (HD) on lipoprotein lipase (LPL) and hepatic lipase (HL) activities and very low density lipoprotein (VLDL), low density lipoproteins (LDL) amounts and compositions were investigated in 58 patients, divided according to HD: GI: under 1 year, GII: 1-5 years, GIII: 5-13 years. HL and LPL activities were reduced in GIII versus GI (P<0.01) and 47% of GIII patients had negligible HL activity. LPL and HL activities were correlated with HD (r=-0.80, P<0.001). Apo C-III concentrations were correlated with HD (r=0.58, P<0.05). Compared with controls, triacylglycerols (TG) were increased in GI, GII (P<0.01) and GIII (P<0.001), and were correlated with HD (r=0.75, P<0.05). VLDL amounts and VLDL-cholesteryl esters (CE) were enhanced in GIII versus GI and GII (P<0.05). VLDL-TG and VLDL-phospholipids (PL) were correlated with HD (r=0.60, P<0.05). LDL-apolipoproteins and unesterified cholesterol (UC) were increased in GII versus GI (P<0.05) and in GIII versus GII and GI (P<0.01). LDL-PLs were decreased in GIII versus GI (P<0.05). Compared with controls, LDL-TGs were higher in GI and GII (P<0.01) and in GIII (P<0.05). Long-term treatment with acetate hemodialysis using cuprophane membrane does not improve lipolytic activity decrease and lipoprotein alterations generated by chronic renal failure (CRF).

Changes in plasma lecithin: cholesterol acyltransferase activity, HDL(2), HDL(3) amounts and compositions in patients with chronic renal failure after different times of hemodialysis.

The aim of this study was to investigate the effect of hemodialysis duration on HDL(2) and HDL(3) compositions and lecithin:cholesterol acyltransferase (LCAT) activity in 58 patients on acetate hemodialysis using cuprophane membrane, after different periods of dialysis. Patients were divided into three groups-GI <1 year, GII 1-5 years, GIII 5-13 years of dialysis and were compared with 22 controls. Increase by 34% of triacylglycerols (TG) was noted in GI and by 36% in GII versus GI. Hypertriglyceridemia was correlated with hemodialysis duration (HD) (r=0.75, P<0.05). The LCAT activity decrease by 25% was noted in GII versus GI (P<0.05) and by 45% in GIII versus GI (P<0.01), this activity was negligible in 33% of GII and 39% of GIII. LCAT activity was negatively correlated with HD (r=-0.80, P<0.001). Hemodialysis duration did not influence HDL(3) and HDL(2) amounts, HDL(3)-phospholipids (PL), HDL(3) and HDL(2)-cholesteryl esters (CE) and HDL(2)-apolipoproteins. However, an increase by 56% in HDL(2)-PL was noted in GIII versus GI and GII (P<0.01). HDL(2)-unesterified cholesterol (UC) were 2-fold higher in GIII than GII and GI (P<0.01). HDL(2)-TG were 2.2-fold higher in GII and 2.4-fold in GIII than GI (P<0.001). HDL(3)-apolipoproteins were 1.5-fold and 1.8-fold lower in GI than GII (P<0.05) and GIII (P<0.01), respectively. An increase in HDL(3)-UC by 20% in GII and 33% in GIII versus GI (P<0.01) was noted. HDL(3)-TG increase by 66% was noted in GII and GIII versus GI (P<0.05). We conclude, that the long-term hemodialysis does not act on lipid anomalies following CRF. Alterations in HDL composition contribute to the reduced efficacy of reverse cholesterol transport, which is a risk factor for cardiovascular disease.