Insulin resistance profile among siblings of type 2 diabetes mellitus (preliminary study).

AIM: to obtain prevalence of insulin resistance among siblings of subjects with type 2 DM and their metabolic abnormality profiles as measured by their BMI, waist circumference (WC), blood pressure, glucose intolerance, concentration of triglyceride, HDL cholesterol, and uric acid. METHODS: a preliminary, cross sectional study conducted among 30 siblings from seven type 2 DM subjects under medical treatment in Dr. Cipto Mangunkusumo Hospital and other places where the subjects lived. Those subjects underwent interviews, physical examination including weight, height, abdominal circumference, blood pressure and laboratory examinations including glucose tolerance test, fasting insulin, triglycerides, HDL cholesterol and uric acid level. Data processed to obtain body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA-IR cut-off, which is determined based on 75 percentile. The criteria of hypertension, dyslipidemia, central obesity and hyperglycemia are based on Asian modification NCEP/ATP III criteria for metabolic syndrome. Hyperuricemia is diagnosed based on uric acid level >7mg/dl in men and >6 mg/dl in women. RESULTS: the prevalence of insulin resistance among siblings of type 2 DM in this study is 26.67% with the proportion in each family varies from 0% to 75%. The most metabolic component found in this study is central obesity (56.7%), followed by hypertension (46.7%), decreased HDL cholesterol level (26.6%), hyper-triglyceridemia (26.6%) and hyperglycemia (20%). As many as three-quarters of subjects with insulin resistance have BMI >25 kg/m2. Among subjects with insulin resistance, all have central obesity, half of them have hypertension, decreased HDL cholesterol level and hyper-triglyceridemia. While hyperglycemia is found in 37.5% subjects. CONCLUSION: the prevalence of insulin resistance among siblings of type 2 DM in this study was 26.67% with the proportion in each family varies between 0-75%. Central obesity is the most metabolic component commonly found.

Prevalence of metabolic syndrome using NCEP/ATP III criteria in Jakarta, Indonesia: the Jakarta primary non-communicable disease risk factors surveillance 2006.

AIM: To obtain the prevalence of MetS in Jakarta, as a capital city of Indonesia. METHODS: Data were obtained from surveillance of primary non-communicable disease in five regions in Jakarta, Indonesia, conducted in 2006. Targeting for 1,800 samples, we performed a purposive and simple random sampling of subjects within the age range of 25-64 years old in selected sampling areas, and stratified random sampling by adjusting to age and sex within those selected sampling areas. We use The WHO Step Wise in collecting data. We also collected blood sample for total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride level. The ATP III modified Asian criteria require the presence of 3 or more of the following: 1. Abdominal obesity (waist circumference ≥ 90 cm in men and ≥ 80 cm in women; 2. A high triglyceride level (≥ 150 mg/dL); 3. A low HDL-cholesterol level < 40 mg/dL for men and < 50 mg/dL for women); 4. High blood pressure (systolic ≥ 130 mmHg or diastolic ≥ 80 mmHg; and 5. A high fasting plasma glucose concentration (≥ 110 mg/dL). RESULTS: Among 1,591 subjects, there are 641 men (40.3%) and 950 women (59.7%). The crude prevalence of MetS using the ATP III modified Asian criteria is 28.4% with prevalences in men and women are 25.4 and 30.4% respectively. The prevalences of MetS in NGT, prediabetes, and diabetes group are 16.4, 35.1, and 73.4% respectively. The prevalences of MetS and central obesity in prediabetes group and diabetes group are higher significantly than those in normal glucose tolerance group (p<0.01). The most common component of MetS in men is hypertension (84.7%), followed by hypertriglyceridemia (83.4%), central obesity (75.5%), hyperglycemia (50.9%) and low HDL-cholesterol (43.6%). While in women, the most common component is central obesity (84.1%), followed by hypertension (84.1%), hypertriglyceridemia (66.1%), low HDL-cholesterol (57.8%), and hyperglycemia (50.2%). CONCLUSION: The prevalence of MetS in this study is 28.4%. The most component found in men is hypertension while in women is central obesity.

The correlation between body fat distribution and insulin resistance in elderly.

AIM: to find the correlation between total body fat, truncal subcutaneous fat, peripheral subcutaneous fat, waist circumference and insulin resistance in elderly METHODS: a cross sectional study was conducted in patients aged 60 years or more who visited the Geriatric Outpatient Clinic at Department of Internal Medicine, Cipto Mangunkusumo National Central General Hospital, Jakarta. Subcutaneous fat thickness was measured by using caliper at 5 different sites. Truncal subcutaneous fat was measured at subscapular, suprailiaca and abdomen; whereas peripheral subcutaneous fat was measured at tricep and thigh region. Total body fat was assessed by using Bioelectrical Impedance Analysis. Index of insulin resistance was measured by using HOMA-IR. RESULTS: from November 2008 to January 2009, there were 55 elderly subjects who fulfilled criteria. There were significant correlations between HOMA-IR and percentage of total body fat (r=0.318; p=0.018), truncal subcutaneous fat (r=0.347; p=0.01), peripheral subcutaneous fat (r=0.296; p=0.028), and waist circumference as index of visceral fat (r=0.361; p=0.007). Other results included our finding on the correlation between BMI and percentage of total body fat (r=0.8; p=0.000), truncal subcutaneous fat (r=0.844; p=0.000), peripheral subcutaneous fat (r=0.706; p=0.000), and waist circumference (r=0.874; p=0.000). There were tendencies of decreasing body fat distribution, BMI and HOMA-IR along with increasing age. Moreover, there was also a tendency of increasing HOMA-IR with increasing BMI. CONCLUSION: this study showed a positive correlation between percentage of total body fat, truncal subcutaneous fat, peripheral subcutaneous fat, waist circumference and insulin resistance in elderly.

Clinical picture, insulin resistance, and adipocytokines profiles of nonalcoholic steatohepatitis (NASH) patients in Indonesia.

AIM: To know the clinical picture of subjects with NASH in Jakarta, Indonesia and the prevalence of insulin resistance, TNF-a, and adiponectin levels among them. METHODS: this was a comparative cross-sectional study between patients with histopathologically confirmed NASH and normal subjects. The population of study was patients with fatty liver without history or significant consumption of ethanol. Patients were consecutively enrolled in the study if the ultrasonography showed fatty liver appearance with or without increased liver transaminases. RESULTS: Thirty patients and thirty normal subjects were recruited between February 2005 and January 2006. Median age of the patients was 45 years while the median age of the control group was 32 years. More than 80% of the patients were overweight (BMI 23-25 kg/m2) and obese (BMI > 25 kg/m2). Increased alanine aminotransaminase levels were found in almost two thirds of the patients. Other comorbidities included hypertension, hypertriglyceridemia, and type-2 diabetes mellitus. In patients with NASH, fasting insulin level, insulin resistance, and TNF-a level were significantly higher, whereas adiponectin level was significantly lower than the control group. CONCLUSION: Most of the metabolic syndrome determinants were found in patients with NASH. HOMA-IR and TNF-alpha levels in subjects with NASH are higher than those in controls. Adiponectin levels in subjects with NASH are lower than those in controls. Further epidemiological studies are still needed to elaborate the causal relationship of insulin resistance and cytokine profiles to the development of NASH in Indonesia.

Dyslipidemia in newly diagnosed diabetes mellitus: the Jakarta primary non-communicable disease risk factors surveillance 2006.

AIM: To obtain the prevalence of dyslipidemia and other cardiovascular risk factors in subjects with undiagnosed DM in Jakarta, Indonesia. METHODS: Data were obtained from surveillance of primary non-communicable disease in five regions in Jakarta, Indonesia, conducted in 2006. Targeting for 1,800 samples, we performed a purposive and simple random sampling of subjects within the age range of 25-64 years old in selected sampling areas, and stratified random sampling by adjusting to age and sex within those selected sampling areas. DM was diagnosed according to WHO criteria after an oral glucose test, i.e fasting blood glucose > or = 126 mg/dL or post loading blood glucose > or = 200 mg/dL and subjects had no history of DM. Dyslipidemia was diagnosed if triglyceride > or = 150 mg/dL, HDL-cholesterol in men < 40 mg/dL or < 50 mg/dL in women and total cholesterol > or = 200 mg/dL. RESULTS: From 1,591 subjects, comprising 640 men and 951 women, the prevalence of newly diagnosed DM is 8.4%. Among this subjects, the prevalences of hypercholesterolemia, hypertriglyceridemia and low HDL-cholesterol are 66.1 (OR 2.28; P=0.004), 54.3 (OR 3.02; P= 0.0001) and 38.6% (OR 2.27; P=0.009) respectively. The prevalence of dyslipidemia in subjects with newly diagnosed DM remains higher among all age groups than that in subjects without DM. CONCLUSION: the prevalence of dyslipidemia among subjects with newly diagnosed DM is higher than that in subjects without DM.

Correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength in Indonesian elderly women living in three nursing homes.

AIM: to investigate the correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength. METHODS: this was a cross-sectional correlative study, conducted at three nursing homes in Jakarta and one nursing home in Bekasi in January 2005. The subjects were women aged 60 years or above. Those selected study subjects underwent quadriceps femoris muscle strength examination with Cybex dynamometer with 150 degrees/second speed, twice (three repetitions with 30 second rest time). The 25 (OH)D concentration was measured by ELISA. RESULTS: out of 67 subjects who met the required criteria for this study, five subjects withdrew from the study during muscle strength examination. The mean age was 71.1 (SD 7.2) years old while the mean serum vitamin D concentration was 68.2 (SD 21.6) nmol/l. Vitamin D deficiency (

Correlation between vitamin D concentration and basic functional mobility in elderly women.

AIM: to determine vitamin D serum concentration, the timed up and go (TUG) test score, and the correlation between vitamin D serum concentration and TUG test score of elderly women. METHODS: a correlative cross-sectional study of elderly women aged 60 years old or above was carried out in three nursing homes in DKI Jakarta and one elderly nursing home in Bekasi, in January 2005. TUG test was performed to evaluate basic functional mobility by measuring the time in seconds to stand from 46 cm height armchair, walk three meters, turn around, and return to full sitting in chair. Vitamin D serum concentration was measured by ELISA method. Calcium ion serum concentration that was measured by NOVA method, age and body mass index (BMI) were confounding variables. RESULTS: of forty-two elderly women who met the inclusion and exclusion criteria, thirty subjects which proportional randomly assigned participated in this study. Mean (+SD) vitamin D serum concentration was 68.0 (21.1) nmol/L, with concentration < 50 nmol/L was 23.3%, TUG score was 10.7 (2.1) seconds, BMI was 22.3 (3.7) kg/m2, age was 70.2 (6.4) years, and median (minimum-maximum) ionized calcium serum concentration was 1.095 (1.030-1.230) mmol/L. Vitamin D serum concentration did not show significant correlation with TUG (r = -0.008; P = 0.968). There were also no significant correlations among the confounding variables and TUG. The correlation with TUG for BMI r = 0.014; P = 0.942, ionized calcium serum concentration r = 0.287; P = 0.124, and age r = 0.315; P = 0.09. CONCLUSION: vitamin D serum concentration has not show significant correlation with basic functional mobility of elderly women, the higher vitamin D serum concentration was not followed by lesser time to perform TUG test; the proportion of subjects with TUG score < 10 seconds (freely mobile in functional mobility) were lesser in vitamin D deficiency respondents.

The effect of menopause on bone mineral density and bone-related biochemical variables in Indonesian women.

OBJECTIVE: To determine the effects of menopause on bone-related variables in Indonesian women and to compare them with corresponding data in Caucasian Australian women. DESIGN: A study of bone-related variables in women aged 45-55 years in Jakarta compared with corresponding historical data from Caucasian Australian women. MEASUREMENTS: Dietary intakes, bone mineral density (BMD) and calcium-related variables in blood and urine. RESULTS: Dietary calcium, phosphorus and protein intakes were significantly lower in the women from Jakarta than in those from Adelaide (all P < 0.001), probably because of lower milk consumption, but energy intake was similar in the two cities. Indonesian women were shorter and lighter than Australian women (P < 0.001) but had a comparable body mass index (BMI). The Indonesians also had a lower spinal BMD than the Australians but this was accounted for by the differences in height and weight between the two populations. The differences in serum and urinary calcium and phosphate and serum alkaline phosphatase across the menopause were comparable in Indonesian and Australian women but creatinine excretion was 25% lower in Jakarta than in Adelaide (P < 0.001) and this was probably sufficient to account for higher ratios of some urinary solutes to urinary creatinine in the Indonesians. Serum 25-hydroxyvitamin D (25OHD) levels were significantly lower (P < 0.001) and serum PTH levels significantly higher (P = 0.0045) in Jakarta than in Adelaide. CONCLUSIONS: The differences in bone-related biochemical variables across the menopause were similar in the two populations, but calcium and protein intake and urine creatinine were lower in Indonesian than in Australian women. Serum 25OHD was lower and PTH higher in the Indonesian women, probably because of their darker skin, their practice of avoiding direct sunlight and the heavy atmospheric pollution in Jakarta.

Left ventricular diastolic dysfunction in obese women.

AIM: To determine the direct effect of obesity on echocardiographic indices of diastolic left ventricular function METHODS: 44 obese (BMI > or =25 kg/m2) and 45 normal weight women were studied. They had no other pathological conditions. Echocardiographic indices of diastolic function were obtained, and dysfunction was assumed when at least two values differed by > or =2 SD from the normal weight group. RESULTS: In obese subjects, the values of maximum velocity of active mitral filling (A) were increased and pulmonary diastolic velocity was decreased significantly (p< 0,01); all other diastolic variables were unchanged. Subclinical diastolic dysfunction tend to be more prevalent among obese subjects but it was not significantly different from non obese (p= 0.11), being present in nine obese (20.5%) and 4 normal (8.9%) subjects. CONCLUSION: Subclinical left ventricular diastolic dysfunction is present in obese women.

The correlation between insulin resistance and left ventricular systolic function in obese women.

AIM: To determine the correlation between insulin resistance and left ventricular systolic function in obese women. METHODS: 44 obese (BMI > or =25 kg/m2) and 45 normal weight women were studied. They had no other pathological conditions. Echocardiograms were undertaken in our echocardiographic laboratory following standard methods. The homeostasis model was used to assess insulin resistance (HOMA IR). RESULTS: Ejection fraction (p =0.22) and fractional shortening (p= 0.58) were not difference between obese women and the normal group. There was no correlation between insulin resistance and left ventricular systolic function. CONCLUSION: There was no correlation between insulin resistance and left ventricular ejection fraction.

Insulin resistance and metabolic syndrome in elderly women living in nursing homes.

AIM: To obtain a depiction of insulin resistance and to determine the correlation between age, body mass index, and insulin resistance, and the prevalence of metabolic syndrome in elderly women living in nursing homes. METHODS: Ninety two elderly females with an average age of 71.4 (SD 7.45) who did not suffer from chronic renal disease or chronic liver disease and were not taking corticosteroids, beta blockers, thiazides, or anti-dyslipidemic drugs, participated as research subjects. Investigated variables, comprising blood pressure, body mass index, waist circumference, laboratory measurements, lipid profile, fasting blood glucose level, and fasting insulin level, were used to determine insulin resistance according to HOMA-IR > 75 percentile. The NCEP ATP III criteria Asia Pacific modification was used to determine metabolic syndrome. RESULTS: There were twenty three subjects with insulin resistance (HOMA-IR > 2.67) for the 75th percentile. Seventeen of them (73.9%) had metabolic syndrome. However, out of the 6 subjects (26.1%) without metabolic syndrome, 5 subjects had at least one component of metabolic syndrome. There was no correlation between age and insulin resistance. However, there was a correlation between BMI and insulin resistance (p<0.017). There were 53 elderly females (57.6%) with metabolic syndrome; the most common metabolic syndrome component being hypertension (79.3%), followed by HDL hypocholesterolemia (55.4%), and central obesity (53%). As many as 32.1% of subjects with metabolic syndrome also demonstrated insulin resistance. CONCLUSION: The value of insulin resistance was 2.67 (HOMA-IR cut-off > 75 percentile). Subjects with insulin resistance had at least one component of metabolic syndrome. A high prevalence (57.6%) of metabolic syndrome in elderly females living in a nursing home was found.