Zeitschrift für metabolisches Syndrom

NAFLD is an emerging problem in Asia, with raising prevalence and strong impact on the health care system. More and more people will suffer from not only the liver impairment of NAFLD but also the associated metabolic diseases e.g. DM and hypertension. The incidence of DM, hypertension, coronary heart diseases (CHD) and stroke will increase together with the prevalence of NAFLD and the health service expenditure will rise in coming decades. However the prevalence of and the metabolic diseases associated with NAFLD are not well studied in Asian populations. The objective of this project is to systematically review the articles related to NAFLD.

Aim: Pathologic fractures occur as a result of weakening of the mechanical properties of bone. There are many conditions, which lead to bone softening. There are neoplastic and non-neoplastic diseases that cause pathologic fractures. The aim is to evaluate and to highlight on value of prophylactic fixation of impending fractures in abnormal bone situation to prevent occurrence of pathological fracture and its complications.

Patients and methods: Between 2003 and 2009, study on forty-nine patient (35 females and 14 males) between the age of 20 and 65 years with an average age of 49.9 years with expected possibility of fractures of lower extremities. The entire patient with fractures risks prophylactic fixation has done. Different types of fixation either surface plating (dynamic hip screws), medullary (Gamma nails or locking nail) or external fixation in cases unsuitable for surgery was used according to the type and the site of the deformity in combination of management of primary condition.

Results: Most patients had significant relief of pain. 35 (71.5%) of patients with impending fracture were ambulatory after therapy and able to walk outdoor while 10 (20.5%) of patients could walk inside door. Three patients (6%) using wheel chair, and they were on renal dialysis. Only one patient (2%) was not able to walk, and he was not cooperative for unknown reason. The mean duration of hospitalization was 21 days (range from 7 to 35 days). That time included preoperative period of investigation and preparation and post-operative surgery and rehabilitation.

Discussion: Pathological fractures create a serious morbidity in patients with bone disease. Orthopedic surgeons who look after patients with skeletal lesions should focus on proactive treatments designed to prevent pathologic fractures before they occur. Prophylactic fixations have decreased morbidity compared with patient's sustained fractures before fixation.

Conclusion: Surgical fixation of fractures in weight-bearing long bones with impending fractures provides pain relief, and a functionally stable and durable construct. It helps early an ambulation and prevents fracture's complication. It allows independent function and avoids irretrievable catastrophes.

Type 2 Diabetes mellitus (T2D) is a worldwide chronic epidemic with increasing incidence. The current algorithm for medical management of type 2 diabetes includes the pharmacological treatment with nine classes of anti-diabetic drugs. Among the nine classes of drugs approved, metformin, an oral hypoglycemic agent from the biguanide family is widely prescribed as the first-line anti-diabetic monotherapy for the treatment of initially diagnosed T2D individuals. The failure of monotherapy to achieve sustain glycemic control prompted the early use of aggressive combination therapies with other anti-diabetic drugs. The primary aim of T2D treatment is to achieve target glycemic control and reducing further complications of diabetes. Hence, fixed dose combination drugs are preferable in order to reduce pill burden and capital investment. Single pill combinations containing drugs for two different diseases can also be prescribed for avoiding extra medication and to reduce further diabetic complications. Our review addresses the mode of action of anti-diabetic drugs and their combinatorial therapy with metformin.

Background: To compare cardio metabolic characteristics of Asian Indians with incident type 2 diabetes diagnosed by Oral Glucose Tolerance Test (OGTT) or by Glycosylated Haemoglobin (HbA1c).

Research Design and Methods: Data from two Indian Diabetes Prevention Studies in persons with Impaired Glucose Tolerance (IGT) was used. In 314 persons, diabetes was diagnosed by OGTT and another 67 persons had only HbA1c values ≥ 6.5% (≥48 mmol/mol). Cardiometabolic characteristics were compared in 3 sub-groups-1: Persons with positive OGTT only (HbA1c<6.5% (<48 mmol/mol) (n=125), 2: Persons with positive HbA1c but negative OGTT (n=67), 3: Those with both HbA1c and OGTT positive (n=189).

Results: Diagnostic sensitivity of HbA1c was 67.2% when compared with OGTT criteria. Prevalence of obesity, abdominal obesity, hypertension, insulin resistance and lipid abnormalities were similar in all groups. Persons in groups-1 and 2 had similar metabolic characteristics, but for higher plasma glucose in the former group and higher HbA1c in the latter group. Prevalence of abnormalities was similar in both groups. Group with both the tests positive, had higher levels of insulin resistance.

Conclusion: Metabolic characteristics of incident diabetic cases identified either by OGTT or by HbA1c were similar, except for a higher prevalence of insulin resistance among those who had both tests positive.

Objective: Obesity is characterized by the abnormal or excessive deposition of fat in the adipose tissue. Besides being a risk factor for cardiovascular diseases, certain cancers and type II diabetes, obesity has been suggested to be a risk factor for periodontitis. A number of epidemiological studies have studied the association between obesity and periodontitis. The aim of this study was to determine the relationship between periodontitis and overweight/ obesity in subjects aged 28-55 years.

Study design: A representative sample of the population, which was enrolled in a study, was examined. A total of 300 chronic periodontitis subjects had a clinical periodontal examination and their weight and height were recorded. Periodontal parameters were: probing pocket depth, clinical attachment level, bleeding on probing, gingival inflammation and presence of visible plaque. In the control group there were 100 periodontal healthy subjects. Moderate periodontitis was identified when teeth had attachment loss of <6 mm and a pocket depth<5 mm, and severe periodontitis with attachment loss ≥ 6 mm and pocket depth ≥ 5 mm. Body weight was measured using body mass index.

Results: Researchers have found a significant association between obesity and prevalence of periodontal disease, among the population aged 28-55. Obesity was associated with periodontitis after adjustment for confounders. Greatest association was found between BMI and severe periodontitis measured by periodontal parameters.

Conclusion: The data suggest that obesity is associated with periodontitis. Obese individuals might be at risk for initiation and progression of periodontitis.

Background: Insulin resistance is characteristic of patients with metabolic syndrome and it’s more pronounced in overweight patients. In the long term there may be cardiovascular and pressor consequences. Lifestyle and diet changes may partly improve these aspects. The use of insulin-sensitizing drugs such as metformin gives good results, although side effects limit its use. Recently, new molecules exerting a similar effect without side effects have been put on the market, such as the d-chiro-inositol, a new insulin-sensitizing molecule. Have been proposed various associations between inositol and ingredients able to potentiate its therapeutic effect.

Materials and methods: This was a prospective study. 40 women were recruited aged >40 years in perimenopause with metabolic syndrome with insulin resistance, altered lipid parameters and with a BMI>25. Were evaluated: BMI, insulin levels and fasting plasma glucose, lipid profile (total cholesterol, HDL, triglycerides). The patients were divided into 2 groups: group A treated with a new oral product containing d-chiro-inositol 100 mg, monacolin-K 3 mg, bergamot extract 250 mg, methylfolate 200 mcg and natural vitamin K2 45 mcg (Mesix®) in tablets for 6 months, one tablet per day. Group B not treated and followed for 6 months.

Results:The results demonstrated a significant reduction in the levels of almost all parameters in the group treated with this new supplement, without any side effect.

Conclusions:This innovative natural supplement, thanks to the synergy of action of its components, can be a new effective alternative in prevention and treatment of metabolic syndrome in perimenopausal women.

Background: The SNP of the leptin receptor (Lys656Asn) has been related with metabolic parameters. The aim of our design was to evaluate the influence of Lys656Asn variant of Leptin receptor gene on weight loss and metabolic parameters secondary to a high protein/low carbohydrate vs. a standard hypocaloric diets.

Design: A total of 280 obese subjects were randomly allocated to one of two diets during 9 months (Diet HP (high protein-low carbohydrate hypocaloric diet) and Diet S (standard protein hypocaloric diet)).

Results: After both diets and in both genotypes, body mass index (BMI), fat mass, weight, systolic blood pressure and waist circumference decreased, without differences between both diets. With the diet type HP and in both genotypes, triglycerides decreased. In subjects with Lys656Lys genotype, glucose, insulin levels, HOMA-R, total cholesterol and LDL- total cholesterol decreased after HP diet. No statistical changes were detected in Asn allele carriers. After diet S and in patients with Lys656Lys genotypes, only total cholesterol, triglycerides and LDL- total cholesterol decreased, without changes in Asn allele carriers.

Conclusion: Obese subjects with Asn656 allele have a different metabolic response than Lys656Lys genotype subjects, secondary to the same weight loss with two different hypocaloric diets.