12-letnia obserwacja pacjenta z nadciśnieniem tętniczym

Przedstawiono przypadek 12-letniej obserwacji pacjenta z nadciśnieniem tętniczym i zespołem metabolicznym - od momentu rozpoznania nadciśnienia, do rozwoju niewydolności serca i nerek

Anthropometric, metabolic and clinical factors associated with diabetes and prediabetes prevalence in women aged 65–74 living in central Poland

Background. Prevalence of type 2 diabetes mellitus is rising worldwide. Similar trend is also observed in Poland, especially in elderly population. The aim of this cross-sectional study was to assess prevalence and to identify anthropometric, metabolic and clinical factors associated with diabetes and prediabetes among women at early elderliness living in central Poland. Methods. 364 women aged 65–74 years, were included into the study. In all patients a history of diabetes and cardiovascular disease was obtained, blood pressure and anthropometric measurements were performed, blood samples for laboratory tests (fasting plasma glucose, lipid metabolism and creatinine) were drawn, ankle/brachial index was calculated, abdominal ultrasound with abdominal aorta diameter was performed and carotid intima/media thickness was measured. Data were collected during March and April 2012 in Gniewkowo, the rural-urban municipality in central Poland. Results. 98 women had diabetes (25 de novo) and 94 ones had prediabetes (81 de novo). Waist circumference, BMI, lipid abnormalities as well as anthropometric and metabolic indices: waist-to-height ratio (WHtR), triglycerides/HDL cholesterol ratio and visceral adiposity index (VAI) were significantly associated with abnormal glucose metabolism. Backward stepwise logistic regression analysis identified WHtR as the best single indicator of patients with diabetes, while again WHtR and VAI were the only independent indicators of any type of impaired glucose metabolism. Conclusions. Abnormal glucose metabolism is highly prevalent among women at early elderliness, especially in those with visceral obesity and abnormal lipid metabolism. Anthropometric and metabolic indices (WHtR and VAI) were better indicators of impaired glucose metabolism compared to separate measurements of single parameters.Background. Prevalence of type 2 diabetes mellitus is rising worldwide. Similar trend is also observed in Poland, especially in elderly population. The aim of this cross-sectional study was to assess prevalence and to identify anthropometric, metabolic and clinical factors associated with diabetes and prediabetes among women at early elderliness living in central Poland. Methods. 364 women aged 65–74 years, were included into the study. In all patients a history of diabetes and cardiovascular disease was obtained, blood pressure and anthropometric measurements were performed, blood samples for laboratory tests (fasting plasma glucose, lipid metabolism and creatinine) were drawn, ankle/brachial index was calculated, abdominal ultrasound with abdominal aorta diameter was performed and carotid intima/media thickness was measured. Data were collected during March and April 2012 in Gniewkowo, the rural-urban municipality in central Poland. Results. 98 women had diabetes (25 de novo) and 94 ones had prediabetes (81 de novo). Waist circumference, BMI, lipid abnormalities as well as anthropometric and metabolic indices: waist-to-height ratio (WHtR), triglycerides/HDL cholesterol ratio and visceral adiposity index (VAI) were significantly associated with abnormal glucose metabolism. Backward stepwise logistic regression analysis identified WHtR as the best single indicator of patients with diabetes, while again WHtR and VAI were the only independent indicators of any type of impaired glucose metabolism. Conclusions. Abnormal glucose metabolism is highly prevalent among women at early elderliness, especially in those with visceral obesity and abnormal lipid metabolism. Anthropometric and metabolic indices (WHtR and VAI) were better indicators of impaired glucose metabolism compared to separate measurements of single parameters

The cut-off values for non-fasting routine lipid parameters in presumably healthy 9–11-year-old children

Disorders of lipid metabolism cause accelerated atherosclerosis and increase cardiovascular risk, which is why lipid profile screening, especially at a young age, should be widely applied.Aim. The aim of the study was to determine the cut-off points for non-fasting lipid parameters in presumably healthy children aged 9-11 years.Material and methods. The study was performed with the use of blood samples taken in non-fasting state from 289 school children of both sexes (152 girls and 137 boys). Routine lipid profile was assessed: TC, LDL-C, HDL-C, and triglycerides. Laboratory measurements were performed in serum samples using abiochemical autoanalyser.Results. In this study we determined the 97.5 percentile values for TC, LDL-C, and triglycerides and the 2.5 percentile values for HDL-C. The upper cut-offs for TC, LDL-C, and triglycerides were found to be 239 mg/dL, 163 mg/dL, and 284 mg/dL, respectively, and the lower cut-off for HDL-C was 37 mg/dL.Conclusions. The upper range of non-fasting total cholesterol was higher by about 30 mg/dL compared to fasting state for a similar age range; the cut-off points in non-fasting children for LDL-C and TG were also higher. The lower cut-off for HDL-C was similar compared to fasting state for the respective age range. The determination of the non-fasting cut-off values for routine lipid profile in the paediatric population is essential for the proper evaluation of the cardiovascular risk because using the reference values for adults may cause an incorrect interpretation of the laboratory results

Occurrence of hyperlipidemia in relation to body mass index in school children aged 9–11

Background. There is a link between lipid disorders and body mass and the occurrence of cardiovascular diseases. This study aimed at establishing the prevalence of lipid abnormalities in relation to body mass in children aged 9–11. Materials and methods. The study involved 232 presumably healthy school children aged 9-11. Fasting venous blood samples were taken from every child to assess the lipid profile: total cholesterol (TC), LDL cholesterol (LDL-C, direct measurement), HDL cholesterol (HDL-C) and triglycerides (TG). Anthropometric measurements were performed including height and weight, followed by calculating the body mass index (BMI) by using an online “OLAF” calculator. Results. The prevalence of hypercholesterolemia and an elevated concentration of LDL-C in the group of children was high and equaled 51.1% and 34.6%, respectively. Hypertriglyceridemia in the respective age groups of 9 and 10–11 years was found to be: 41.6% and 27.7%. Only in 9.5% of children the level of HDL-C was lower than optimal. The percentage of overweight was two-fold higher among boys than in girls (13.6 v. 6.9%), similarly the percentage of obesity was higher in boys compared with that in girls (15.5 v. 10.3%). Conclusions. In school children aged 9–11 the dominant and most frequent lipid abnormality, not associated with an increased body mass, was hypercholesterolemia followed by hypertriglyceridemia. Overweight and obesity were strongly related to gender and much more frequent among boys. There should be more attention paid to dyslipidemia and body weight already in childhood in the context of health policy and prevention

The relationship between anthropometric parameters and renal function in elderly

Wstęp. Coraz więcej dowodów wskazuje, że otyłość jest czynnikiem przyczyniającym się do rozwoju przewlekłej choroby nerek (PChN). Związek między otyłością i PChN jest złożony i nie do końca poznany. Możliwość wykorzystania wskaźników antropometrycznych w predykcji PChN u osób w podeszłym wieku budzi wątpliwości. Badania takie nie były wcześniej prowadzone wśród populacji polskiej. Cel pracy. Celem pracy była ocena zależności pomiędzy wybranymi parametrami antropometrycznymi u osób w podeszłym wieku a funkcją nerek określoną za pomocą eGFR. Materiał i metody. Badania objęły grupę 222 osób, u których zmierzono wzrost, masę ciała, obwód bioder i pasa. Wyliczono wskaźniki BMI, WHR, WHtR. Przesączanie kłębuszkowe (eGFR) wyliczono ze wzoru CKD-EPI. Wyniki. Przewlekłą chorobę nerek (eGFR < 60) stwierdzono u 53 osób, co stanowi 23,89% wszystkich badanych. Średnie wartości BMI, WHR i WHtR wyniosły odpowiednio 28,99, 0,89, 0,63. Na podstawie BMI nadwagę stwierdzono u prawie 40% badanych, a otyłość u 38%. Za ledwie u 22% osób uzyskano BMI < 25. Nie stwierdzono zależności pomiędzy badanymi parametrami antropometrycznymi a eGFR. Wnioski. Parametry antropometryczne charakteryzujące otyłość brzuszną mają ograniczone zastosowanie w predykcji PChN u osób w podeszłym wieku.Introduction. Increasing evidence suggests that obesity might be one of the important factors in development of chronic kidney disease (CKD). However, the relation between obesity and CKD is complicated and not entirely known. Usage of antropometric measures in prediction of CKD is controversial in elderly. This kind of survey has not been already performed in Polish population. Aim of the study. The aim of this study was to evaluate the relation betweeen selected antropometric measures of obesity and renal function defined by eGFR in elderly. Materials and methods. Anthropometric indexes of obesity including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-hip ratio (WHR), were obtained in 222 participants. eGFR was estimated using CDK-EPI formula. Results. The prevalence of CKD (eGFR < 60) stage ≥ 3 was 23.89%. Overweight and obesity were found in 40% and 38% of participants, respectively. WHtR, WC and WHR were 28.99, 0.89, 0,63. Only 22% of participants had a BMI < 25. There was no correlation between anthropometric parameters and eGFR. Conclusions. Anthropometric parameters of obesity have limited utility in the prediction of CKD in elderly

Prevalence of hypertension and metabolic disturbances in a population-based cohort of postmenopausal women. The Gniewkowo Women Study

Background Metabolic syndrome (MS) constitutes a major determinant of cardiovascular (CV) morbidity and mortality in adults. This phenomenon in women before menopause is attenuated by gonadal hormonal activity. After menopause the CV disease (CVD) incidence among women increases dramatically, and often overtakes the prevalence observed among men. Little is known about the CV-risk characteristic of early postmenopausal women in our country. Therefore the aim of our study was to investigate the frequency and distribution of metabolic syndrome components in early postmenopausal women residing urban-rural area in central Poland. Material and Methods All women aged 65–75 years, opted for one general practice form an urban-rural area in Central Poland were invited to participate. The anthropometric measures, blood pressure and blood sampling were performed. For the purpose of the study, the modified NCEP ATP III criteria for the diagnosis of metabolic syndrome were used. Results 59.5% of eligible women accepted the invitation. Additional 5.2% of randomly selected women from initially non-responders group were added to the investigated population. In the studied group only 15.7% had normal body weight and 82.4% met the criteria for abdominal obesity (92% according to IDF). 81.9% of women were characterized by hypertension, even more met the NCEP ATP III criterion for elevated blood pressure (BP) (91.5%). Only 24.2% of studied women were treated effectively; moreover, despite treatment with three antihypertensive drugs 17.4% hypertensive women did not reach target BP values. Over one quarter of studied women suffered from diabetes mellitus, among whom 25.5% were not aware of the presence of the disease. Another 37.1% of women presented with prediabetic condition. Lipid disturbances were noted in the 25.3% and 18.4% of women for triglycerides (TG) increase and low HDL-C levels, respectively. According to modified NCEP ATP III criteria we were able to diagnose 58.8% of studied women with metabolic syndrome. Additionally, 31.9% of postmenopausal women were active cigarette smokers. Conclusions Metabolic profile of early postmenopausal women in central Poland is strikingly abnormal. High incidence of metabolic syndrome is mainly determined by extremely prevalent increased blood pressure and abdominal obesity. With relation to all identified metabolic syndrome components, the strategy aimed at the improvement of body mass status, diabetes diagnosis and especially blood pressure control appear to be of highest priority

Renal function in the elderly

Wstęp. Określenie funkcji nerek pozwala na wczesną diagnostykę i leczenie przewlekłej choroby nerek (PChN). Z wiekiem dochodzi do zmian w nerkach. Wzrasta częstość występowania chorób prowadzących do PChN. W polskiej populacji osób w podeszłym wieku nie porównywano dotąd funkcji nerek z użyciem różnych wzorów do szacowania przesączania kłębuszkowego (GFR). Cel pracy. Porównanie funkcji nerek u osób w podeszłym wieku na podstawie różnych metod do szacowania GFR. Materiał i metody. Badaniem objęto 234 osoby — 161 kobiet (68,8%) i 73 mężczyzn (31,2%). Średni wiek wynosił 84,36 ± 4,21 lat. Funkcję nerek oszacowano na podstawie wzorów Cockcrofta-Gaulta (CG), Modification of Diet in Renal Disease (MDRD) oraz Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Wyniki. Średnia wartość GFR według Cockcrofta-Gaulta wynosiła 64,93 ml/min/1,73 m2, CKD-EPI — 69,59 ml/min/1,73 m2, MDRD — 82,64 ml/min/1,73 m2. Istotne różnice stwierdzono między wartościami GFR wyliczonymi według MRDR i Cockcrofta-Gaulta (p < 0,001), MRDR i CDK-EPI (p = 0,001); między Cockcrofta-Gaulta i CKD-EPI nie stwierdzono istotnych statystycznie różnic (p = 0,081). GFR < 60 ml/min/1,73 m 2 według Cockcrof ta-Gaulta obserwowano u 111 pacjentów (47,44%), MDRD u 45 pacjentów (19,23%), CKD-EPI u 71 pacjentów (30,34%). GFR < 30 ml/min/1,73 m2 według Cockcrofta-Gaulta obserwowano u 7 pacjentów (3,03%), MRDR u 3 pacjentów, CKD-EPI u 3 pacjentów (1,28%). Wnioski. Stosując różne metody określania GFR , uzyskuje się heterogenne wartości. Różnią się one szczególnie w przypadku wykorzystania wzoru MDRD.Introduction. Definition of kidney function allows for early diagnosis and treatment chronic kidney disease. There are lots of changes in kidneys following with age. The incidence of illnesses leading to chronic kidney disease also increases. In the elderly Polish population, there was no date about comparing kidney function on the basis of different formulas, used to estimate the GFR. Aim of the study. Estimate renal function in the elderly, using various methods to assess GFR. Material and methods. The study included 234 people — 161 women (68.8%) and 73 men (31.2%), the average age was 84.36 ± 4.21 years. Kidney function was estimated on the basis of formulas — Cockcroft Gault (CG), MDRD and CKD-EPI. Results. In the test group, the mean value of the GFR was calculated from the formula Cockcrofta-Gaulta — 64.93 ml/min/1,73 m 2, CKD-EPI — 69.59 ml/min/1.73 m2, MDRD — 82.64 ml/min/1.73 m2. Statistical significant differences were found between the GFR estimated on the basis of the MRDR and Cockcrofta-Gaulta (p < 0.001), MRDR and CDK-EPI (p = 0.001), between the Cockcrofta-Gaulta and the CKD-EPI were not found any statistically significant differences (p = 0.081). GFR < 60 ml/min/1.73 m2 assessed with formula Cockcrofta-Gaulta — 111 patients (47.44%), MDRD — 45 patients (19.23%), the CKD-EPI — 71 patients (30.34%). GFR < 30 ml/min/1.73 m2 assessed with formula Cockcrofta-Gaulta — in 7 patients (3.03%), MRDR — 3 patients, CKD-EPI — 3 patients (1.28%). Conclusions. Using the different formulas to assess eGFR could lead to significant differences in the evaluation of kidney function. They are particularly high in the case of the MDRD formula

Prevalence of obesity in elderly

Wstęp. Otyłość stanowi istotny problem w populacji ogólnej, a szczególnie wśród osób w podeszłym wieku. Przydatność parametrów antropometrycznych stosowanych do oceny stanu odżywienia u osób w podeszłym wieku budzi kontrowersje. Cel pracy. Określenie przydatności wybranych parametrów antropometrycznych w ocenie otyłości w populacji osób w podeszłym wieku. Materiał i metody. Badanie przeprowadzono wśród 230 osób. Wykonano podstawowe pomiary antropometryczne, na których podstawie obliczono indeks masy ciała (BMI), stosunek obwodu talii do bioder (WHR) oraz wskaźnik talia-wzrost (WHtR). Dane analizowano przy użyciu programu LibreOffice Calc i Statistica 10. Wyniki. W badanej populacji 43,9% kobiet i 24,7% mężczyzn było otyłych (BMI ≥ 30). Blisko 93% kobiet i 86% mężczyzn miało nadmierny obwód talii. Wskaźnik talia-wzrost (WHtR) wskazywał na występowanie otyłości centralnej u 94,3% kobiet i 94,5% mężczyzn. Otyłość brzuszną na podstawie WHR stwierdzono u blisko 86% kobiet i 13,7% mężczyzn. Nie wykazano korelacji między badanymi parametrami antropometrycznymi, z wyjątkiem korelacji między obwodem talii (WC) a WHtR (r = 0,706; p = 0,000), która to zależność wynika z faktu, że WHtR jest pochodną WC. Wnioski. W populacji osób w podeszłym wieku otyłość jest bardzo częsta. Brak zależności między parametrami antropometrycznymi świadczy o ograniczonej przydatności tych parametrów w ocenie otyłości u osób w podeszłym wieku.Introduction. Obesity is a crucial problem in general population, especially in elderly. Usefulness of antropometric parameters for evaluation of nutritional state in elderly is controversial. Aim of the study. The aim of this study was to determine the usefulness of selective antropometric parameters in evaluation of obesity in elderly. Material and methods. The research was conducted among 230 elderly. Basic anthropometric measurements were taken in all participants, on the basis of which BMI, WHR, and WHtR were calculated. LibreOffice Calc and Statistica 10 were used to perform data analysis. Results. In this population 43.9% women and 24.7% men were obese (BMI ≥ 30). Nearly 93% women and 86% men had excessive waist circumference. According to WHtR central obesity was in 94.3% women and 94.5% men. Abdominal obesity defined by WHR was in 86% women and 13.7% men. There was no correlation between these antropometric parameters, except for correlation between WC and WHtR (r = 0,706; p = 0,000), which is a result of the fact that WHtR is a derivative of WC. Conclusions. Obesity in elderly is very common. Absence of correlation between antropometric parameters shows that usefulness of them in evaluation of obesity in elderly is limited

Stosowanie leków przeciwcukrzycowych i ryzyko nowotworów u chorych na cukrzycę typu 2

Introduction. The risk of several types of cancer is increased in type 2 diabetes mellitus (T2DM). Impact of antidiabetic medications on this risk is still a matter of controversies. The aim of our observational study was to evaluate the risk of cancer occurrence associated with the most frequently used antidiabetic agents. Patients and methods. 213 patients (118 women) with T2DM who developed cancer while treated for diabetes and 213 subjects with T2DM without cancer, matched by age and gender in a 1:1 case-control manner were included. Date of cancer diagnosis was considered as index time, and for each comparator data from the same calendar time were used. Results. Both in the univariate and in multiple logistic regression analysis metformin use was associated with reduced cancer risk, while elevated risk associated with insulin use was significant only in univariate but not in multiple logistic regression analysis. Insulin and sulfonylurea derivatives in monotherapy were associated with significantly higher cancer risk compared to metformin monotherapy, while in combination with metformin this risk was attenuated to non-significant level. Conclusion. Our study suggests protective effect of metformin and potentially negative impact of insulin and sulfonylurea derivatives on cancer risk. These findings should be interpreted with caution, due to relatively small study group. Nevertheless, to minimize cancer risk associated with antidiabetic medications’ use, metformin should be continued as long as medically acceptable and it should be combined with insulin or SU to neutralize risk associated with using either of the latter drugs in monotherapy.Wstęp. W cukrzycy typu 2 obserwuje się podwyższone ryzyko wystąpienia wielu typów nowotworów. Wpływ leków przeciwcukrzycowych na to ryzyko wciąż pozostaje przedmiotem kontrowersji. Celem niniejszej pracy obserwacyjnej była ocena ryzyka powstania nowotworu złośliwego związanego ze stosowaniem najczęściej używanych leków przeciwcukrzycowych. Materiał i metody. Badaniem objęto 213 pacjentów (118 kobiet) leczonych z powodu z cukrzycy typu 2, u których rozwinęła się choroba nowotworowa, oraz 213 osób z cukrzycą typu 2 bez choroby nowotworowej, dopasowanych pod względem wieku i płci do grupy badanej metodą przypadek–kontrola w stosunku 1:1. Datę rozpoznania cukrzycy przyjęto jako „datę indeksowania” i ta sama data kalendarzowa została użyta dla każdej pary przypadek–kontrola. Wyniki. Zarówno w analizie jednoczynikowej, jak i wieloczynnikowej regresji logistycznej stosowanie metforminy wiązało się z redukcją ryzyka nowotworu, podczas gdy podwyższone ryzyko związane z podawaniem insuliny było znamienne tylko w analizie jednoczynnikowej, ale nie w wieloczynnikowej regresji logistycznej. Stosowanie insuliny i pochodnych sulfonylomocznika w monoterapii wiązało się ze znamiennie podwyższonym ryzykiem wystąpienia nowotworów w porównaniu z monoterapią metforminą, podczas gdy w terapii skojarzonej z metforminą ryzyko to zostało zredukowane do poziomu nieistotnego statystycznie. Wnioski. Wyniki pracy wskazują na ochronne działanie metforminy i potencjalnie niekorzystny wpływ insuliny i pochodnych sulfonylomocznika na ryzyko wystąpienia nowotworów. Rezultaty te powinny być jednak interpretowane z ostrożnością ze względu na relatywnie małą grupę badaną. Niemniej jednak, aby zminimalizować ryzyko nowotworów związane ze stosowaniem leków przeciwcukrzycowych, leczenie metforminą powinno być kontynuowane tak długo, jak długo jest to medycznie akceptowalne i powinna być ona kojarzona z insuliną i pochodnymi sulfonylomocznika w celu neutralizacji ryzyka związanego z podawaniem każdego z tych leków w monoterapii

Antidiabetic medications use and cancer risk in type 2 diabetes

Introduction. The risk of several types of cancer is increased in type 2 diabetes mellitus (T2DM). Impact of antidiabetic medications on this risk is still a matter of controversies. The aim of our observational study was to evaluate the risk of cancer occurrence associated with the most frequently used antidiabetic agents. Material and methods. 213 patients (118 women) with T2DM who developed cancer while treated for diabetes and 213 subjects with T2DM without cancer, matched by age and gender in a 1:1 case-control manner were included. Date of cancer diagnosis was considered as index time, and for each comparator data from the same calendar time were used. Results. Both in the univariate and in multiple logistic regression analysis metformin use was associated with reduced cancer risk, while elevated risk associated with insulin use was significant only in univariate but not in multiple logistic regression analysis. Insulin and sulfonylurea derivatives in monotherapy were associated with significantly higher cancer risk compared to metformin monotherapy, while in combination with metformin this risk was attenuated to non-significant level. Conclusion. Our study suggests protective effect of metformin and potentially negative impact of insulin and sulfonylurea derivatives on cancer risk. These findings should be interpreted with caution, due to relatively small study group. Nevertheless, to minimize cancer risk associated with antidiabetic medications’ use, metformin should be continued as long as medically acceptable and it should be combined with insulin or SU to neutralize risk associated with using either of the latter drugs in monotherapy