Reference values of body composition for adult females who are classified as normal weight, overweight or obese according to body mass index.

OBJECTIVE: The aim of this study was to establish reference values for body composition as measured by Bioelectrical Impedance Analyser (BIA) in adult females without any endocrinological and/or metabolic disorders, according to their body mass index (BMI) grouped as normal, overweight, obese and morbid obese. PATIENTS AND METHODS: This study was performed in a total of 327 adult females. In addition to the estimation of their body weight, height, waist and hip circumference, their body composition was measured by BIA. The results were statistically evaluated by a computer program using ANOVA test. RESULTS: Together with the increase of BMI also the percentage of body fat and basal metabolism (BM) increased significantly, while the percentage of body water, fat free mass as well as lean/fat ratio showed a significant decrease. In addition, waist and hip ratio, percentage of body fat and BM showed a significant positive corelation with BMI. CONCLUSION: These results are recommended to be used as reference values for the studies on body composition, especially to predict the degree of body fatness of obese patients and also nutritional status of patients who need nutritional supports.

Association of Resistin Gene 3'-Untranslated Region EX4-44G-->A Polymorphism with Obesity- and Insulin-Related Phenotypes in Turkish Type 2 Diabetes Patients.

Resistin, an adipocyte-secreted hormone, has been associated with obesity, insulin resistance and type 2 diabetes mellitus (T2DM) in some, but not all, rodent models. In humans, the exact function of resistin is unkown. Because 3'-untranslated region (3'-UTR) single nucleotide substitutions (SNPs) have been shown to affect gene expression, we examined the EX4-44G-->A SNP in the 3'-UTR of exon 3 within the resistin gene. The objective of this study was to investigate, for the first time in a Turkish study group, whether the 3'-UTR EX4-44G-->A variation in the resistin gene influences the development of T2DM, obesity and insulin-related phenotypes. We analyzed the genotype frequencies of the EX4-44G-->A polymorphism of the resistin gene in 116 type 2 diabetic and 102 normal subjects. Serum lipids, obesity-related and insulin-related phenotypes were analyzed. No significant difference for genotypic frequencies were observed for the BseRI restriction site in type 2 diabetic patients as compared to controls. Waist-to-hip ratio, BMI, body fat and apoAI levels were found to be affected by resistin genotype. In the control group, BMI (p < 0.01), HIS (p < 0.05) and BF (p < 0.05) levels were found to be elevated, whereas HOMA beta-cell index (p < 0.01) and apo AI (p < 0.05) levels were found to be decreased in GG genotype carriers. In the diabetic group, the GG genotype carriers were found to have higher BMI levels (p < 0.001), waist-to-hip ratio (p < 0.05), body fat (p < 0.01), HOMA (p < 0.001) and fasting insulin (p < 0.05), but lower HbA1c levels in comparison to GC + AA carriers. These data suggest that, in the Turkish study group, the EX4-44G-->A polymorphism of the resistin gene is associated with insulin and obesity-related phenotypes.

Apolipoprotein B gene variants are involved in the determination of blood glucose and lipid levels in patients with non-insulin dependent diabetes mellitus.

We have examined the frequency of the EcoRI, XbaI and MspI RFLPs of the apolipoprotein B (apo B) gene in 110 type 2 diabetic patients and 91 healthy control subjects in order to ascertain whether variation in this gene may influence the development of non-insulin dependent diabetes mellitus (type 2 diabetes). Serum lipids including total-cholesterol (T-Chol), triacylglycerol (TAG), apolipoprotein E (apo E), apolipoprotein AI (apo AI), apolipoprotein B and lipoprotein (a) (Lp(a)) were analysed. Genomic DNA was extracted and the apo B polymorphic regions amplified by the polymerase chain reaction. Regions carrying EcoRI, XbaI, and MspI restriction sites present in the apo B gene were amplified and digested separately by the respective enzymes. No significant difference for genotypic frequencies was observed for the EcoRI, XbaI and MspI restriction sites in type 2 diabetic patients as compared to controls. Type 2 diabetic patients and controls with EcoRI +/+ and XbaI +/+ genotypes had higher apo E levels. The MspI +/+ genotype is more frequent in the patient and control groups with elevated T-Chol. Furthermore, the EcoRI -/-, XbaI -/-, and MspI +/+ genotypes were found to be significantly more frequent in type 2 diabetic patients with higher blood glucose levels. This study identifies the apo B gene polymorphisms in modulating plasma lipid/lipoprotein and glucose levels in patients with type 2 diabetes.

High prevalence of obesity and diabetes mellitus in Konya, a central Anatolian city in Turkey.

INTRODUCTION: The objective of this study was to determine the prevalence of overweight, obesity, impaired fasting glucose, diabetes and the relationship between adiposity and carbohydrate metabolism, by age and gender in Konya, a city in central Anatolia. METHODS: A cross-sectional population based survey was performed. One month before the field survey a media campaign was started in each district by local municipalities. Ten percent of the target population age 20 and over were invited to participate and the participation rate was 82.1%. Twelve thousand eight hundred and sixty-six inhabitants (7000 women and 5866 men, mean age 46.7+/-15.9 years) were evaluated for height and body weight between May and September of 2001. Two thousand eight hundred and thirty consecutive subjects (1788 women and 1042 men, mean age 48.2+/-15.7 years) were tested for fasting blood glucose in addition to an anthropometric evaluation. RESULTS: The crude IFG rate was 24% (27.1% in women and 18.5% in men) and the diabetes rate 8.4% (8% in women and 9.1% in men). The survey identified previously undiagnosed diabetes in 3.7% (4.3% of women and 2.9% of men). The prevalence of diabetes (p=0.0005) and obesity (p=0.0005) increased with age. Obese men and women had a higher risk of being diabetic than their normal weight counterparts (OR, 2.05; CI 95%, 1.13-3.71; p=0.0186 and OR, 2.53; CI 95%, 1.57-4.07; p=0.0001, respectively). Overall, the overweight rate was 34.2% (33.5% of women and 36.3% of men) and the obesity rate was 23.7% (32.4% of women and 14.1% of men) (n=12,866). Women had a significantly higher risk of being obese than men (OR, 2.84; CI 95%, 2.62-3.08; p=0.0005). The diabesity rate was 3.4% (4.1% in women and 2.1% in men). CONCLUSION: Carbohydrate intolerance and adiposity are highly prevalent in Konya, and the two conditions are positively correlated with each other, by age and gender.

The clinical characteristics of latent autoimmune diabetes in adults and its relation with chronic complications in metabolically poor controlled Turkish patients with Type 2 diabetes mellitus.

It has been reported that some patients with Type 2 diabetes mellitus (DM) have latent autoimmune diabetes in adults (LADA) and may show different clinical characteristics than those with Type 2 DM. We aimed to determine the ratio and clinical features of LADA in patients with diagnosed initially as Type 2 DM. We measured glutamic acid decarboxylase antibodies (GADA) in 54 patients, diagnosed clinically with Type 2 DM. Of 54 patients, 17 (31%) were GADA positive. GADA-positive patients had significantly earlier diabetes onset age (P<.001), lower BMI (P<.05), and lower serum C-peptide value (P<.001) than did those who were GADA negative. A higher proportion of the GADA-positive patients were receiving insulin therapy (P<.01). With respect to the duration of DM, familial history of DM, and the levels of blood pressures, fasting plasma glucose, and HbA1c, there was no difference between the two groups. Nephropathy and retinopathy were more frequent in GADA-positive than in GADA-negative patients. The prevalence of neuropathy was comparable between the two groups. GADA was negatively associated with BMI, C-peptide levels, and diabetes-onset age, but positively related to retinopathy, nephropathy, and insulin treatment. This study indicated that the important portion of the patients who were initially diagnosed as Type 2 DM may have LADA. In Type 2 diabetic patients who have lower BMI and diagnosis of diabetes in relatively younger age, the possibility of LADA should be taken into consideration. The higher prevalence of nephropathy and retinopathy in GADA-positive patients also suggests the importance of early diagnosis and strict metabolic control in these patients.

The effects of experimental hypothyroidism on hemorheology and plasma fibrinogen concentration.

Effects of hypothyroid on hemorheology of patients had widely attracted the attention of researchers during last decade. The present study has been planned with the purpose to determine the effects of experimental hypothyroidism on hemorheological parameters and fibrinogen concentration. To induce experimental hypothyroid methimazole (75 mg/100 g) was added to the fodder of an experimental group rats for 20 d. After experimental duration, plasma and blood viscosity, hematocrit (Hct), hemoglobin, erythrocyte rigidity index, and plasma fibrinogen concentration values of both the control and the experimental group animals were determined and evaluated. The serum T3 and T4 levels of the experimental group were found lower (p < 0.001) but TSH level higher (p < 0.001) than that of the control group. Plasma viscosity and fibrinogen concentration of hypothyroid group were found significantly higher than controls (p < 0.01). Hematocrit and hemoglobin values were also found lower in the experimental group than the control group animals (p < 0.01). However, there was no significant difference found in blood viscosity at the original Hct value but there was a significant increase at standard Hct value (p < 0.01). There was also no change in erythrocyte rigidity index between control and experimental groups. According to these results it may be said that in hypothyroidism, increased fibrinogen concentration may alter the rheological structure of blood by inducing increase in plasma viscosity.

DNA polymorphism of Pvu II site in the lipoprotein lipase gene in patients with non-insulin dependent diabetes mellitus.

We studied the effect of variation at the lipoprotein lipase (LPL) gene locus on the susceptibility of individuals with non-insulin dependent diabetes mellitus (NIDDM) in a population of 110 NIDDM patients and 91 controls. Our objective was to study the relationship between the LPL-Pvu II polymorphism and NIDDM and lipid metabolism. PCR-RFLP was used to determine the DNA polymorphism of the sixth intron of the LPL gene. The frequencies of the genotypes in case and control groups were 29.1 and 30.8% for P+/P+; 45.5 and 36.3% for P+/P-; 25.5 and 33% for P-/P- respectively. There was no significant difference in frequencies of genotypes between the two groups. Logistic regression analysis revealed that triacylglycerol (TAG) and apolipoprotein E levels were associated with NIDDM, whereas Pvu II genotypes were not found as independent risk factors for the disease. Overall this study demonstrates the role of the Pvu II polymorphism in the LPL gene in modulating plasma lipid/lipoprotein levels in patients with NIDDM.

Erythrocyte osmotic fragility and oxidative stress in experimental hypothyroidism.

The present study was planned to explain the relation between erythrocyte osmotic fragility and oxidative stress and antioxidant statue in primary hypothyroid-induced experimental rats. Twenty-four Spraque Dawley type female rats were divided into two, as control (n = 12) and experimental (n = 12), groups weighing between 160 and 200 g. The experimental group animals have received tap water methimazole added standard fodder to block the iodine pumps for 30 d (75 mg/100 g). Control group animals were fed tap water and only standard fodder for the same period. At the end of 30 d blood samples were drawn from the abdominal aorta of the rats under ether anesthesia. T3, T4, and TSH levels were measured and the animals that had relatively lower T3, T4, and higher TSH levels were accepted as hypothyroid group. Hormone levels of the control group were at euthyroid conditions. Osmotic fragility, as a lipid peroxidation indicator malondialdehyde (MDA), antioxidant defense system indicators superoxide dismutase (SOD) and glutathione (GSH) levels were measured in the blood samples. Osmotic fragility test results: There was no statistically significant difference found between maximum osmotic hemolysis limit values of both group. Minimum osmotic hemolysis limit value of hypothyroid group was found to be higher than that of control group values (p < 0.02). The standard hemolysis and hemolytic increment curve of the hypothyroid group drawn according to osmotic fragility test results was found to be shifted to the right when compared to control group's curve. This situation and hemolytic increment value, which shows maximum hemolysis ratio, is the proof of increased osmotic fragility of the erythrocytes in hypothyroidism. There is no statistically significant difference found between hypothyroid and control groups in the lipid peroxidation indicator MDA and antioxidant indicators SOD and GSH levels. As a result of our study it may be concluded that hypothyroidism may lead to an increase in osmotic fragility of erythrocytes. But the increase in erythrocyte osmotic fragility does not originate from lipid peroxidation.

Angiotensin-I converting enzyme gene polymorphism in Turkish type 2 diabetic patients.

Non-insulin dependent diabetes mellitus is often associated with some complications such as nephropathy, retinopathy and neuropathy. Genes of the renin angiotensin system are potential candidate genes for diabetic complications. We investigated the relationship between angiotensin converting enzyme (ACE) gene polymorphism in type 2 diabetic patients with and without diabetic nephropathy. Seventy five patients (25 type 2 diabetic patients with nephropathy, 50 type 2 diabetic patients without nephropathy) and 37 healthy controls were studied. Gene polymorphism of ACE was determined by PCR (polymerase chain reaction) amplification using allele-spesific primers. The frequencies of ACE DD, ID and II genoypes among the patients with type 2 diabetic patients were found 48%, 42%, 10% whereas in control subjects, 27%, 60%, 13% respectively. Type 2 diabetic patients carrying DD genotype without nephropathy increased 1.77 fold than control subjects (P < 0.05). There is no significant correlation between diabetic nephropathy and ACE gene polymorphism. But we found that ACE DD genotype increased significantly in type 2 diabetic patients compared to control subjects (P <.05).

Effects of ACE inhibition on the expression of type IV collagen and laminin in renal glomeruli in experimental diabetes.

In the present study, we examined electron microscopically and immunohistochemically the effects of perindopril, an angiotensin-converting enzyme inhibitor, on renal microangiopathy in streptozotocin-induced diabetes in rats. To investigate changes in glomerular basement membrane (GBM) and tubular basement membrane components, we immunohistochemically localized type IV collagen and laminin. Animals have been divided into three groups of eight adult male rats each. The first group was the non-diabetic control group. The second group consisted of untreated diabetic rats. The third group consisted of diabetic rats that were treated with perindopril for 6 weeks. Blood glucose levels and body weight were measured. Morphometric analysis of kidney tissue was performed using light and electron microscopy to quantify glomerular size and thickness of the GBM. Blood glucose levels in diabetic rats were significantly increased when compared with non-diabetic controls. Blood glucose levels were not affected by perindopril treatment. Untreated diabetic rats showed increased glomerular size, thickening of the GBM and an increase in mesangial matrix as compared with controls. Treatment with perindopril prevented effectively glomerular hypertrophy and thickening of the GBM. Significant increase in type IV collagen and laminin was found in thickened GBM and mesangial matrix in kidneys of untreated diabetic rats. In perindopril-treated diabetic rats, staining of type IV collagen and laminin was less strong when compared with untreated diabetic rats. In conclusion, our data suggest that perindopril treatment is effective in preventing renal lesions possibly by ameliorating the diabetes-induced increase in expression of type IV collagen and laminin.

Iron supplementation in experimental hyperthyroidism: effects on oxidative stress in skeletal muscle tissue.

This study was designed to investigate the effects of iron supplementation on the parameters of oxidative stress in the skeletal muscle tissue of hyperthyroidism induced rats. Hyperthyroidism was found to cause an increase in thiobarbituric acid-reactive substances (TBARS) and copper zinc superoxide dismutase (Cu, Zn SOD) activity, but decreases in the glutathione-peroxidase (GSH Px) activity and glutathione (GSH). Iron supplementation caused an increase in TBARS and a decrease in GSH. Iron supplementation in hyperthyroid rats attenuated the hyperthyroid state, but lowered the plasma ferritin level, which is considered an indicator of thyroid hormone action. Iron supplementation caused no additional increase in the TBARS in hyperthyroid rats, ameliorated the decrease in GSH content and abolished the induction of Cu, Zn SOD. Our findings suggested no increase, but a decrease, in the risk of oxidative stress in iron supplemented hyperthyroid rats. Whether supplementation of iron would have similar effects in humans should be further investigated in clinical studies.

Thiols, malonaldehyde and total antioxidant status in the Turkish patients with type 2 diabetes mellitus.

Non-insulin dependent (Type 2) diabetes mellitus (NIDDM) is a risk factor for cardiovascular diseases (CVD). Oxidative stress mechanisms are often reported to be implied in type 2 diabetes mellitus. In order to determine their clinical relevance, we investigated several plasma indicators in the Turkish patients with NIDDM: (i) homocysteine (Hcy) and cysteine (Cys) which contribute to increase the risk of atherosclerosis during NIDDM, (ii) glutathione (GSH) and cysteinylglycine (CysGly) resulting from GSH degradation catalyzed by gamma-glutamylcysteine transferase (GGT), (iii) malonaldehyde (MDA) as a marker for lipid peroxidation, and (iv) total antioxidant status (TAS). Our main results were evaluated based on sex and diabetic status. In female patients, plasma concentrations of MDA and Hcy were significantly higher than in controls, while GSH levels were significantly lower. In males, a difference between control and diabetic groups was noticed only for Hcy, levels being also higher in patients. In the diabetic group, increase in serum glucose concentration was significantly correlated with increased GGT activity. In both controls and diabetic patients, GGT activity was correlated with a raised Cys concentration and a decreased GSH level. In both controls and diabetic patients, there were significant positive correlations between Cys and Hcy and between GSH and Hcy. We concluded that GSH and MDA levels are clinical indicators for an oxidative process linked to type 2 diabetes mellitus, especially in women.

Relation of erythrocyte Na+-K+ ATPase activity and cholesterol and oxidative stress in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetic patients are at high risk of atherosclerotic complications, and factors associated with this include hypercholesterolemia, hemorheologic disturbances in erythrocytes and oxidative stress. We, therefore, carried out a study in type 2 diabetic patients to determine the relationships of erythrocyte Na+-K+ ATPase activity, plasma cholesterol and oxidative stress in this population. METHODS: Erythrocyte Na+-K+ ATPase activity and its relationship between plasma cholesterol and thiobarbituric acid reactive substance (TBARS, a marker of oxidative stress) were studied in type 2 diabetic patients with (n = 26) or without angiopathy (n = 30). Na+-K+ ATPase activity was measured by a colorimetric enzymatic method. Plasma TBARS levels were determined spectrophotometrically. Diabetic patients were classified according to plasma cholesterol concentrations as normo- or hypercholesterolemic (plasma total cholesterol > 5.18 mmol/L). RESULTS: Diabetic patients with or without angiopathy had lower erythrocyte Na+-K+ ATPase activity (p < 0.001 and p < 0.001 respectively) and higher plasma TBARS levels than healthy subjects (n = 20) (p < 0.001 and p < 0.001 respectively). Na+-K+ ATPase activity in the diabetic patients with angiopathy was lower than in the diabetic patients without angiopathy (p < 0.001). In the diabetic patients both with and without angiopathy, hypercholesterolemic patients had lower erythrocyte Na+-K+ ATPase activity and higher plasma TBARS levels than normocholesterolemic patients (p < 0.001, p < 0.001 respectively) There was no difference in the plasma TBARS concentrations between diabetic patients with and without angiopathy. There were negative correlations between erythrocyte Na+-K+ ATPase activity and both plasma cholesterol (r = -0.72) and plasma TBARS (r = -0.46) and a positive correlation between plasma cholesterol and TBARS (r = 0.42). CONCLUSIONS: Elevated plasma cholesterol may be responsible for the inhibition of erythrocyte Na+-K+ ATPase activity. Together with elevated cholesterol, free radical-induced mechanisms may be involved in the inhibition of Na+-K+ ATPase activity.

Hyperuricemia in hypothyroidism: is it associated with post-insulin infusion glycemic response?

This experimental study was designed to examine whether hyperuricemia in hypothyroidism is associated with insulin resistance. For induction of hypothyroidism, rabbits (n = 12) were administered methimazole orally (75 mg/100 g food) for 30 days. T3, T4 and TSH values measured in plasma prior to and at the end of the experimentation period revealed the establishment of hypothyroidism. In the euthyroid and hypothyroid states of rabbits, crystalline porcine insulin was administered (0.1 unit/kg body weight) intraperitoneally and plasma glucose was measured at 0, 15, 30, 45 and 60 minutes. Sum of post insulin infusion glucose values was considered to reflect insulin resistance. Creatinine clearance (GFR) and uric acid clearance (CuA) were determined. Additionally, triglycerides were measured in plasma and Mg2+ both in erythrocytes and in plasma. Due to hypothyroidism: i) The glycemic response to insulin was not altered. ii) GFR and CuA were both decreased but CuA/GFR unchanged. iii) Triglycerides in plasma decreased. iv) Mg2+ concentration increased in plasma whereas decreased in erythrocytes. Several associations were observed between the variables on correlation analysis. On the basis of our data, it could be suggested that insulin resistance does not exist in hypothyroidism. Hyperuricemia observed in hypothyroidism should be considered to be secondary to decreased renal excretion but not as an indicator of insulin resistance.

Prevalence of overweight and obesity in Turkey.

The objectives of this study were to determine the prevalence of overweight and obesity in Turkey, and to investigate their association with age, gender, and blood pressure. A crosssectional population-based study was performed. A total of 20,119 inhabitants (4975 women and 15,144 men, age > 20 years) from 11 Anatolian cities in four geographic regions were screened for body weight, height, and systolic and diastolic blood pressure between the years 1999 and 2000. The overall prevalence rate of overweight was 25.0% and of obesity was 19.4%. The prevalence of overweight among women was 24.3% and obesity 24.6%; 25.9% of men were overweight, and 14.4% were obese. Mean body mass index (BMI) of the studied population was 27.59 +/- 4.61 kg/m(2). Mean systolic and diastolic blood pressure for women were 131.0 +/- 41.0 and 80.2 +/- 16.3 mm Hg, and for men 135.0 +/- 27.3 and 83.2 +/- 16.0 mm Hg. There was a positive linear correlation between BMI and blood pressure, and between age and blood pressure in men and women. Obesity and overweight are highly prevalant in Turkey, and they constitute independent risk factors for hypertension.

Glutathione S-transferase and O6-methylguanine DNA methyl transferase activities in patients with thyroid papillary carcinoma.

Alkylating agents, which are metabolized by glutathione S-transferase (GST), have an important role in the etiology of cancer by forming mutagenic DNA adducts. Previous studies have shown that DNA repair protein, O6-methylguanine DNA methyltransferase, repairs these mutagenic DNA adducts and its activity is correlated with the resistance of human tumors to alkylating agent-based anti-cancer drugs. However, little is known about GST and O6-methylguanine DNA methyltransferase activities in patients with thyroid cancer in vivo. We measured the activities of GST and O6-methylguanine DNA methyltransferase in the leukocytes from patients with papillary thyroid carcinoma and healthy controls. The GST activity was significantly higher in men than in women, and it was negative correlated with age in men whereas it was unchanged in women in the control group. Both GST and O6-methylguanine DNA methyltransferase activities were significantly increased in the patient group. There were no age and sex-related changes in the O6-methylguanine DNA methyltransferase activity in both the control and patient groups. These results suggest that leukocyte GST and O6-methylguanine DNA methyltransferase activities were increased with thyroid cancer. This may be related to the resistance to chemotherapy exhibited by patients with thyroid cancer.