WCIM 2014
12 32nd World Congress of Internal Medicine (October 24-28, 2014)
OS-END-12 Endocrinology
Is There a Correlation Between Paraoxanase-1 Activity, MPV and Other Atherosclerotic Risk Factors in Predia- betic and Diabetic Patients?
Meral MERT1, Yildiz OKUTURLAR2, Pinar KARAKAYA1, Asuman GEDIKBASI4, Filiz ISLIM3, Ozlem HARMANKAYA2, A.Baki KUMBASAR2
Bakirköy Dr. Sadi Konuk Research and Training Hospital, Endocrinology and Metabolism,Turkey1, Dr. Sadi Konuk Research and Training Hospital, Internal Medicine, Turkey2, Dr. Sadi Konuk Research and Training Hospital, Radiology,Turkey3, Dr. Sadi Konuk Research and Training Hospital, Biochemistry, Turkey4 Background: It has been reported that MPV is increased in diabetes while the status of MPV in prediabetes is not well known. It has been reported that decreasing level of paraoxonase-1 is related to increased probability of development of atherosclerosis and cardiovascular disease (CVD). In this study we compared the mean platelet volume (MPV), paraoxonase-1 (PON) and arylesterase (ARE) levels in patients with the diagno- sis of prediabetes and diabetes mellitus (DM).
Methods: Forty fi ve prediabetic patients and 135 type 2 diabetic patients were en- rolled into the study. Height, weight, BMI, age, gender, smoking, alcohol, exercise, fam- ily history of DM and CVD, childbirth, menopause status of all patients were recorded.
Routine biochemical tests and A1c, lipid profi les, homocysteine, PON, ARE and MPV levels were performed.
Results: Mean age of diabetics and prediabetic patients are 53.4 ±13.7 and 53.0±12.8 respectively. Age, weight, height, BMI and MPV levels were not signifi cantly differ- ent in both groups but PON, ARE, A1c and HOMA levels were signifi cantly different (p=0.0001). There were no signifi cant differences in smoking, hypertension, hyperlip- idaemia, exercise, coronary heart disease between the two groups. There was no sig- nifi cant correlation between MPV and PON, ARE but there was a negative correlation between A1c, glucose, WBC values and PON, ARE. We also found a negative correla- tion between triglyceride and PON levels and microalbuminuria and ARE levels.
Conclusions: There was no difference in MPV level in both groups having different risk of atherosclerosis and probably because of the limited number of prediabetic patients in our study. However, lower levels of PON and ARE may have been caused by high risk of atherosclerosis in diabetic patients. It would be more reliable to analyse MPV, PON and ARE according to biochemical and clinical conditions.
OS-END-13 Endocrinology
The Relationship Between Sarcopenia and Non-Alco- holic Fatty Liver Disease: The Korean Sarcopenic Obesi- ty Study
Ho Cheol HONG1, Ja Young RYU1, Hye Jin YOO1, Ji A SEO1, Sin Gon KIM1, Nan Hee KIM1, Sei Hyun BAIK1, Dong Seop CHOI1, Kyung Mook CHOI1
College of Medicine, Korea University, Korea1
Background: Previous studies have shown that non-alcoholic fatty liver disease (NAFLD) and sarcopenia may share pathophysiological mechanisms, such as insulin re- sistance, infl ammation, vitamin D defi ciency, and decreased physical activity. However, their direct relationship has not been investigated.
Methods: The association between NAFLD and sarcopenia was examined in 452 apparently healthy adults enrolled in the Korean Sarcopenic Obesity Study (KSOS), an ongoing prospective observational cohort study. The liver attenuation index (LAI), which measured using abdominal computed tomography (CT), was used as a parame- ter for the diagnosis of NAFLD. Sarcopenia was defi ned using a skeletal muscle mass index (SMI) [SMI (%) = total skeletal muscle mass (kg) / weight (kg) x 100] that was measured by dual energy X-ray absorptiometry (DXA).
Results: After adjusting for age and sex, both SMI and LAI were negatively correlated with the homeostasis model assessment of insulin resistance (HOMA-IR) (P<0.001) and high sensitivity C-reactive protein (hsCRP) (P<0.001) as well as brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness. Furthermore, SMI and LAI had positive relationships with HDL-cholesterol, but both had a negative relationship with triglyceride, alanine aminotransferase (ALT), and total body fat. In a multiple logistic regression analysis, the odds ratio for NAFLD risk was 5.16 (95% CI = 1.63-16.33) in the lowest quartile of SMI compared to the highest after adjusting for potential con- founding factors.
Conclusions: Individuals with lower muscle mass exhibited increased risk of NAFLD.
This result may provide a novel insight into the mechanism linking between sarcopenia and NAFLD.
OS-END-14 Endocrinology
Optimization of Screening for Mild Cushing Syndrome Among Patients with Obesity
Maria Antonenko1, Natalia VOLKOVA1, Ilya DAVIDENKO1, Igor RESHETNIKOV1, Irina DZHERIEVA1
Rostov State Medical University, Russia1
Background: There has been proven high prevalence of mild Cushing Syndrome (CS) among patients with obesity. Approach to screening couldn’t be based on specific signs of hypercortisolism in this case. Thus, search of potential opportunities of opti- mization of screening for mild CS is of great importance.
Methods: There were performed a retrospective analysis of 198 patients with obesity, among whom 6 had proved diagnosis of CS and 192 had suspected but not proved diagnosis CS. Noone had specifi c signs of CS. In order to develop statistic model that allows to estimate the probability of CS presence there was used logistic regression.
As potential predictors there were chosen age, BMI, waist circumfl ex, total cholesterin, triglycerides, lipoproteins low density, fasting plasma glucose, systolic and diastolic blood pressure. In order to assess the effi cacy of developed model, there was further tested on 6 patients with mild CS and 54 patients with suspected but not proved CS.
Results: There was developed the logit regression equation with waist circumflex, total cholesterin and fasting plasma glucose as predictors. The percent concord- ance made 98,8%. Force of communication of the fact and prediction according to D-Zomer was 0,975. Reclassifi cation of case observations with developed equation showed the following: 1 patient with CS had 7% probability to have CS whereas other 5 patients with CS had probability more than 83% to have CS. 50 patients without CS had probability to have CS less than 7%; 4 patients – no more 38%. Since screening model should have greater sensitivity than specifi city, the probability of CS 7% was chosen as a threshold
Conclusions: Great advantages of such kind of models is a objective selection of pa- tients, standardization of a technique and lack of need for additional fi nancial expens- es for its use.
OS-END-15 Endocrinology
A Study of Endothelial Dysfunction by Flow Mediated Dilatation of Brachial Artery in Euglycemic & Hyperg- lycemic Individuals
Sarath MENON1, Girish RAMTEKE1, Dharmendra JHAVAR1, Manoj GUPTA1 MGM Medical College and MY Hospital, India1
Background: Endothelial dysfunction is regarded as an early marker for atherosclero- sis & a precursor for future cardiovascular events.
Objectives: Study was done to fi nd out endothelial dysfunction (ED) in euglycemic &
hyperglycemics. fi nding any endothelial dysfunction in high risk euglycemic & pre-di- abetic individuals and compared degree of ED with different types of hyperglycemia, glycemic parameters & common cardio-vascular (CV) risk factors.
MATERIAL & Methods: A cross-sectional, prospective study was done in subjects divided into two groups. First group included hyperglycemic individuals (80) Pre-dia- betes(20), Type1DM(20), Type2 DM (34), clinically labeled MODY(06) and second group included 40 euglycemic individuals. Body mass index, fasting lipid profi le, FBS, PPBS, RBS, HbA1c were obtained. Endothelial dependent fl ow mediated dilatation was as- sessed with 7.5MHz high resolution ultrasound of brachial artery. A p-value of <0.05 was considered to be statistically signifi cant.
Results: Flow mediated dilatation was impaired with increase in age, BMI, lipid profi le (p=0.04,0.02,0.02 respectively). FMD was seen inversely related to all glycemic pa- rameters like FBS(r=.680,p=<0.001),PPBS(r=-.660,p=<0.001),RBS(r=.680,p=<0.001), HbA1c(r=-.820,p=<0.001).Flow mediated dilatation was impaired in Pre-diabetes, Type 1 DM,Type2 DM, Clinical MODY,but did not show signifi cant difference between each other (9.03+0.73% vs 8.21+1.18% vs 6.95+2.14% vs 9.4+0.45%,p=0.20) but had sig- nifi cant difference when compared to euglycemics (14.01+3.06%,p=<0.001).FMD was impaired even in high-risk euglycemics(p=0.02)
Conclusion: Results showed impaired endothelial function in hyperglycemics and endothelial dysfunction was seen even in Pre-diabetes and in high risk euglycemic individuals, thus showing endothelial damage in these early stages. Endothelial func- tion declined with increase in the severity of glycemic parameters and common CV risk factors. Our study suggested FMD should be considered as a surrogate marker for future cardiovascular events.
