Ketogenic Diet Is Good for Aging-Related Sarcopenic Obesity

Sarcopenic obesity is a skeletal muscle weight loss disease. It has happened at an elderly age. A ketogenic diet is a low-carbohydrate (5%), moderate protein (15%), and a higher-fat diet (80%) can help sarcopenic obese patients burn their fat more effectively. It has many benefits for muscle and fat weight loss. A ketogenic diet can be especially useful for losing excess body fat without hunger and for improving type 2 diabetes. That is because of only a few carbohydrates in the diet, the liver converts fat into fatty acids and ketones. Ketone bodies can replace higher ATP energy. This diet forces the human body to burn fat. This is a good way to lose fat weight without restriction

Comparison of Carotid Ultrasound Indices and the Triglyceride Glucose Index in Hypertensive and Normotensive Community-Dwelling Individuals: A Case Control Study for Evaluating Atherosclerosis

Background and objectives: Hypertension (HTN) is an important risk factor for cardiovascular diseases. High blood pressure is a major cause of atherosclerosis which leads to myocardial infarction and stroke. Insulin resistance (IR) is correlated with HTN and atherosclerosis. To determine differences between the effects of HTN on the intima media thicknesses (IMTs) of the internal (ICA), external (ECA), and common carotid arteries (CCA), and evaluate the carotid plaque presence between hypertensive and normotensive individuals, a case-control study was designed among community-dwelling individuals. The relationship between the triglyceride glucose (TyG) index and atherosclerosis was also investigated in this study. Materials and Methods: Data from 77 hypertensive and 199 normotensive individuals were analyzed in this study. Results: The IMTs of the CCA, ICA, and ECA, and the TyG index were all higher in hypertensive individuals compared to the control group (all p < 0.05). After controlling for age, sex, the body-mass index, and TyG index, HTN was an independent predictor of a high CCA IMT (odds ratio (OR) = 2.48; 95% confidence interval (CI) = 1.24–4.93) and presence of plaque (OR = 2.36; CI = 1.15–4.85) in the carotid artery. Conclusions: HTN was an independent risk of carotid IMT thickening and atherosclerosis. TyG index could only predict the CCA IMT independent of other risk factors (OR = 2.09; CI = 1.07–4.09)

Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients

[[abstract]]Da Silva et al. showed that the triglyceride-glucose (TyG) index was positively associated with a higher prevalence of symptomatic coronary artery disease (CAD). TyG has been used in healthy individuals as a marker of insulin resistance. The use of this index as a marker of atherosclerosis in cardiovascular disease (CVD) patients might be influenced by diabetes and the hyperlipidemic state that led to CVD. Certain considerations might be necessary before we conclude that the TyG index can be used as a marker of atherosclerosis in CVD patients. These factors can highlight the role of fasting blood glucose and triglyceride levels that are used in the TyG formula. Comparing the fasting blood glucose and/or triglyceride levels with the TyG index in these patients to show how much value the TyG index can add to clinical practice seems to be necessary. Conclusions of such studies might be biased by these facts. Stratification by CAD disease category cannot help achieve an understanding of the role of TyG in CVD. Correlations do not imply causation, so the use of the TyG index as an index in CAD patients is questionable. We read with great interest the article by da Silva et al. [1] on how the triglyceride-glucose (TyG) index was associated positively with a higher prevalence of symptomatic coronary artery disease (CAD) and with the metabolic and behavioral risk factors that this study evaluated; the researchers concluded that this biomarker can be used as a marker for atherosclerosis. Recent studies have widely used the TyG index as a marker of insulin resistance. It has been shown that a higher TyG index is associated with an increased risk of major adverse cardiac and cerebrovascular events in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) [2] and that the risk of ischemic stroke correlates with a proportional and linear increase in the TyG index [3]. Zhao et al. [4] showed that an elevated TyG index is significantly associated with a higher risk of arterial stiffness and nephric microvascular damage. The TyG index is also used as a valuable biomarker for diabetes development, as it has shown an association with the risk of incident diabetes [5]. As da Silva et al. [1] mentioned, the TyG index is calculated as Ln (fasting triglycerides (mg/dl) × fasting blood glucose (mg/dl)/2). Although Moon et al. [6] stated that this index was proposed by Guerrero-Romero et al. [7] in 2010, we found that this index had been used by Simental-Mendia et al. [8] in 2008, using the same calculation for the first time in a large population-based cross-sectional study of healthy individuals. The rationale for why they used this index was that insulin resistance is a common cause of the increase in triglyceride and glucose levels in healthy individuals. In patients with apparent cardiovascular disease and diabetes, the use of this measure might be biased and have less diagnostic value than expected. Da Silva et al. [1] included patients who had at least one cardiovascular disease (CVD) in the last 10 years and stratified them into three groups: (a) asymptomatic, (b) symptomatic and (c) treated for CAD. As they calculated the TyG index in all these patients, they observed a statistically significant difference only in the symptomatic group (Group b), as the higher TyG index tercile had a higher prevalence of symptomatic patients. They confirmed their conclusion by performing regression analyses on all groups and observing that these results were robust even after controlling for sex, age, and use of hypoglycemic, antihypertensive, anticoagulant and lipid-lowering agents. It is worth noting that all of the patients included in their study were at risk of CAD because they had a previous history of CVD. Diabetes has been considered a main risk factor for CAD [9]. Triglycerides are well-known independent risk factors for CVD [10]. Da Silva et al. [1] did not report any statistics stratified by CVD, so there is a high possibility that many of the patients in the symptomatic group had the same characteristics regarding the controlled factors (included in the regression model, especially the use of hypoglycemic, antihypertensive, anticoagulant and lipid-lowering agents), so controlling for these variables does not greatly influence the conclusion. The fact that more symptomatic patients belonged to the higher tercile of the TyG index can be easily explained by the fact that they had uncontrolled diabetes and/or hyperlipidemia, leading to high TyG index levels, as TyG has a direct relationship with triglycerides and glucose (based on the TyG formula). We can observe that this pattern is not seen in the other two groups: Groups a and c (asymptomatic and treated groups), as they have probably controlled these factors (good treatment and lifestyle habits in asymptomatic and good treatment regime and medications in the treated group). Another point that is missing in this article is the fact that the authors could compare the diagnostic values of fasting glucose and triglyceride levels (and maybe the combination) with the TyG index and then try to show that the TyG index can have a better diagnostic value than fasting glucose and triglyceride levels. A medical doctor usually looks first at fasting glucose and triglyceride levels to screen high-risk patients, especially CVD patients. How can the TyG index add to the prognostic values of triglyceride and glucose levels? The fact that CVD is a dynamic and progressive disorder and that the initiation of treatment should be based on the specific situations of the patients makes using indexes such as the TyG index as prognostic markers less certain. Using the TyG index in CVD patients can be easily biased by diabetes and hyperlipidemia, and these factors should be well controlled to justify its use as a biomarker. We should not infer reverse causality in the application of the TyG index in CVD patients

Comment on Nakai, Y.; Makizako, H.; Kiyama, R.; Tomioka, K.; Taniguchi, Y.; Kubozono, T.; Takenaka, T.; Ohishi, M. Association between Chronic Pain and Physical Frailty in Community-Dwelling Older Adults. Int. J. Environ. Res. Public Health 2019, 16, 1330, doi:10.3390/ijerph16081330

In their report, Nakai et al [...

Factors associated with carotid Intima media thickness and carotid plaque score in community-dwelling and non-diabetic individuals

Abstract Background The carotid intima media thickness (cIMT) and carotid plaque score (cPS) are respective markers of early and late stage subclinical atherosclerosis. Relationships between some laboratory parameters and subclinical atherosclerosis are not yet clear in community dwelling individuals and non-diabetic subjects, so we try to elucidate these relationships and find a model to predict early and late stage subclinical atherosclerosis. Methods We examined relationships of the cIMT and cPS with different laboratory and demographic data of 331 subjects from a community-based prospective cohort study, using univariate and multivariate analyses. Results In regression models and after multiple adjustments, only systolic blood pressure (SBP), age, glycated hemoglobin (HBA1c), and waist circumference (WC) were determinants of the cIMT, and only age, SBP, HBA1c, and blood urea nitrogen (BUN) were determinants of a cPS of > 2 in all individuals. Only HBA1c lost its association with regard to predicting the cIMT in non-diabetic subjects. Conclusions HBA1c at > 5.9% can determine early and late stage subclinical atherosclerosis in community dwelling individuals, but only late stage subclinical atherosclerosis in non-diabetic subjects

Value of the arterial stiffness index and ankle brachial index in subclinical atherosclerosis screening in healthy community-dwelling individuals

Abstract Background Carotid intima media thickness (cIMT) and the carotid plaque score (cPS) are valid markers for detecting subclinical atherosclerosis. Evaluation of ASI and ABI for detection of atherosclerosis is assessed in this study. Finding a model to see which individual has a risk of having atherosclerosis, so those people can be further assessed by invasive but more accurate atherosclerosis detection methods like angiography is another objective of this study. Methods Data of 212 healthy community-dwelling subjects, consisting of carotid duplex records, ASI and ABI measurements, certain laboratory tests, and related cardiovascular disease (CVD) risks were analyzed for correlations. Results The ABI was independently associated with high cPS. Age, hypertension and Waist circumference are determinants of subclinical atherosclerosis as in high cIMT and high cPS. Conclusions The use of the ASI cannot replace carotid ultrasound in detecting subclinical atherosclerosis because it is not independently associated with high cIMT and cPS while ABI can be used in detection of high cPS in healthy community-dwelling individuals. Public health policies to encourage weight reduction and treating hypertension can help prevention of subclinical atherosclerosis in healthy community-dwelling individuals. Models consist of age, body compositions like waist circumference and hypertension history can be used in further assessment of atherosclerosis

Comparison of Carotid Ultrasound Indices and the Triglyceride Glucose Index in Hypertensive and Normotensive Community-Dwelling Individuals: A Case Control Study for Evaluating Atherosclerosis

Background and objectives: Hypertension (HTN) is an important risk factor for cardiovascular diseases. High blood pressure is a major cause of atherosclerosis which leads to myocardial infarction and stroke. Insulin resistance (IR) is correlated with HTN and atherosclerosis. To determine differences between the effects of HTN on the intima media thicknesses (IMTs) of the internal (ICA), external (ECA), and common carotid arteries (CCA), and evaluate the carotid plaque presence between hypertensive and normotensive individuals, a case-control study was designed among community-dwelling individuals. The relationship between the triglyceride glucose (TyG) index and atherosclerosis was also investigated in this study. Materials and Methods: Data from 77 hypertensive and 199 normotensive individuals were analyzed in this study. Results: The IMTs of the CCA, ICA, and ECA, and the TyG index were all higher in hypertensive individuals compared to the control group (all p < 0.05). After controlling for age, sex, the body-mass index, and TyG index, HTN was an independent predictor of a high CCA IMT (odds ratio (OR) = 2.48; 95% confidence interval (CI) = 1.24–4.93) and presence of plaque (OR = 2.36; CI = 1.15–4.85) in the carotid artery. Conclusions: HTN was an independent risk of carotid IMT thickening and atherosclerosis. TyG index could only predict the CCA IMT independent of other risk factors (OR = 2.09; CI = 1.07–4.09)

Reporting a Rare Case of Pleomorphic Adenoma of the Breast

Pleomorphic adenoma (PA) is the most common tumor type in the salivary gland. PA is uncommon in the breast tissue. Only 73 cases of PA of the breast have been reported in the world literature. We are reporting the 74th case of PA of the breast. A 61-year-old woman was referred to Shahid Beheshti Hospital Obstetric Clinic with bloody painless discharge from the right nipple. A bean size mass was detected immediately below the right nipple. After an excisional biopsy, the pathologist found proliferation in epithelial and myoepithelial cells that had small and multiple nuclei, myxoid and chondroid stroma. Immunohistochemistry stain was positive for S-100 and patchy for GFAP in tumor cells and for SMA around the tubule-glandular and tumor cell aggregates and suggested PA of the breast. It is essential for the pathologists to consider PA of the breast as a differential diagnosis of a rounded circumscribed mass in the juxta-areolar areas. Careful paraffin sections should be performed to avoid an unnecessary mastectomy