Maximal post-prandial triglyceride increase reflects post-prandial hypertriglyceridaemia and is associated with the insulin resistance syndrome

Aims To assess the value of maximal post-prandial triglyceride increase after a high fat, low carbohydrate (CHO) test meal, as index of post-prandial hypertriglyceridaemia and its relation with insulin resistance. Methods Fifty non-diabetic subjects, 22 male and 28 female, aged 52.1 +/- 4.5 and 56.9 +/- 3.8 years, were studied. Glucose, insulin and triglycerides were measured fasting and 1, 2, 3 and 4 h after a meal consisting of 40 g fat, 19 g protein and 10 g CHO. Insulin resistance was calculated according to the HOMA model. Results The maximal triglyceride increment occurred during the 4th hour. Its absolute value (Delta -TG) and the per cent increase over the fasting value (PTI), were considered appropriate for the evaluation of the post-prandial triglyceride response. Both Delta -TG and PTI were strongly correlated with triglycerides incremental area in males and females, r = 0.797 and r = 0.700, P < 0.01 and r = 0.805 and r = 0.774, P < 0.001, respectively, and thus they can be used as indices of the post-prandial triglyceride response. No correlation was found between fasting triglyceride and triglyceride incremental area or Delta -TG. Thus, post-prandial hypertriglyceridaemia can occur irrespectively of the fasting triglyceride concentrations. A weak correlation was found between PTI and insulin resistance in females, r = 0.384, r < 0.05, but not in males, r = 0.224, P > 0.05. However further analysis by quartiles of PTI showed similar insulin resistance levels in the first three quartiles and a significant increase in the 4th, both for males and females, 4th vs. 3rd quartile 7.4 +/- 3.6 vs. 2.2 +/- 0.7 and 6.4 +/- 2.4 vs. 2.2 +/- 0.6, respectively. The 4th quartile corresponds to a PTI greater than or equal to 80%. Conclusions PTI after the high fat, low CHO test meal used, consistently reflects post-prandial hypertriglyceridaemia, is easily measured and it is not predicted by fasting triglycerides. A PTI greater than or equal to 80% is associated with a significant increase of insulin resistance, and might therefore be considered the cut-off point for an abnormal post-prandial hypertriglyceridaemic response, at least in relation with insulin resistance. Such response could be added to the abnormalities of the insulin resistance syndrome, as an independent parameter

INFLUENCE OF 5-FLUOROURACIL ON SERUM-LIPIDS

The effect of the cytotoxic drug 5-fluorouracil (5-FU) on plasma lipid levels was studied in patients and animals. Seven patients with metastatic carcinoma of the colon and three with advanced breast cancer were treated with 5-FU monotherapy by i.v. push at a dose of 500 mg/m(2)/d for 3-5 consecutive days. The animal group comprised 9 rabbits treated with 5-FU by i.v. push at 12-18 mg/kg/d for 2 consecutive days. Measurements of serum lipid levels were performed before and 2 and 4 weeks after 5-FU administration. No obvious change of diet, body weight and bowel habits occurred during the study period. A significant reduction of total plasma cholesterol was observed in both patients and animals. The triglyceride levels were also reduced in the rabbits. Maximal cholesterol-lowering effect was observed in patients and rabbits with higher baseline cholesterol levels. The results suggest that 5-FU might interfere with lipid metabolism

Hyperglycaemia in pregnancy in Mediterranean women.

New diagnostic criteria have recently been proposed that will result in a higher proportion of individuals being diagnosed as suffering from gestational diabetes mellitus (GDM) than previously. The present circum-Mediterranean study sets out to identify the relevance of the new criteria in this population. The study was a prospective, non-interventional, multicentre study in the Mediterranean region. A convenient sample of 1,368 pregnant women was recruited. All participants underwent a 75 g oGTT subdivided into five different glycaemic categories. The women's anthropomorphic and biological data, together with obstetric and infant outcomes, were collected. There was a threefold increase in diagnosis using the new criteria. Most of the biological characteristics generally associated with GDM showed high specificity and low sensitivity values. The biological characteristics, including maternal age, BMI and FBG, showed a progressive increase as a function of maternal glycaemia with moderate sensitivity and specificity values. Using these latter characteristics in combination ensures that 72.3 % of the GDM population would be correctly identified, while an oGTT would only be required in 18.7 % of the population. The progressive relationship of increasing glycaemia to adverse characteristics suggests that the new IADPSG criteria are reasonable provided that dietary advice is given to all pregnant women. In situations of economic restraints, it appears possible to screen Mediterranean women for GDM risk using a composite model using FBG >5.0 mmol/l combined with the performance of an oGTT in women with a low FBG but who are overweight and aged >30 years

A composite risk assessment model to screen for gestational diabetes mellitus among Mediterranean women.

OBJECTIVE: To determine whether clinical risk assessment for gestational diabetes mellitus (GDM) may preclude the need for universal screening with an oral glucose tolerance test (OGTT) in situations of economic restraint. METHODS: Women with either GDM (n=119) or normal glucose tolerance (n=1249) were recruited from centers among 11 Mediterranean countries between August 1, 2010, and May 31, 2011. Outcome measures included anthropomorphic and biological data, obstetric outcomes, and infant outcomes. RESULTS: Significant risk factors for GDM included maternal age of 30 years or more; elevated body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters); elevated diastolic blood pressure; previous history of macrosomia; and family history of diabetes mellitus. These factors each had high specificity but low sensitivity for predicting GDM; however, when used in combination, sensitivity increased but specificity fell. Fasting blood glucose (FBG) level had high sensitivity (73.9%) and specificity (90.2%) for predicting GDM. Sensitivity was further increased by combining FBG measurement with maternal age and BMI (96.6%). CONCLUSION: Use of a composite model to prescreen women for GDM risk may reduce the need for universal screening with the OGTT among centers facing health-cost pressures

The ORListat and cardiovascular risk profile in patients with metabolic syndrome and type 2 Diabetes (ORLICARDIA) study

Background: Metabolic syndrome (MetSyn) is associated with a marked increase in the risk of cardiovascular disease, especially in patients with type 2 diabetes mellitus (DM). Aim: To investigate the effect of orlistat plus hypo-caloric diet (HCD) vs HCD alone on the cardiovascular risk profile in patients with both MetSyn (National Cholesterol Educational Program-NCEP-Adult Treatment Panel III definition) and type 2 DM. Methods: This was a prospective, multicentre, open-label, randomized, controlled study. One hundred and twenty-six patients, free of cardiovascular disease at baseline, were included in the final analysis. Ninety-four (73%) patients were treated with orlistat (360 mg/day) and HCD for a 6-month period, while 34 (27%) were on HCD alone. Analysis of covariance was used to assess differences between the treatment groups over time. Main outcome measures: Components of the MetSyn criteria assessed were: waist circumference; systolic and diastolic blood pressure; fasting glucose, triglycerides; high-density lipoprotein cholesterol (HDL-C) plus body mass index; glycosylated haemoglobin (HbA(1C)); homeostasis model for assessment of insulin resistance (HOMA) index; and total and low-density lipoprotein cholesterol (LDL-C). Results: By protocol, all patients had MetSyn at baseline. After a 6 month treatment period there were significant differences between the orlistat plus HCD vs the HCD-alone groups in body weight (p = 0.0001), waist circumference (p < 0.0001), fasting glucose (p < 0.0001), HbA(1C) (p < 0.0001), systolic blood pressure (p = 0.024), total cholesterol (p < 0.0001), LDL-C (p = 0.034), and HOMA index (p = 0.022), while there were no significant differences in triglycerides and HDL-C. Orlistat was well tolerated. By the end of the study, 65% of the patients on orlistat plus HCD were still meeting the MetSyn criteria and 41% had four to five MetSyn components vs 91% (p < 0.0001) and 53% (p = 0.017), respectively, of those on HCD alone. Conclusions: Orlistat plus HCD favourably modified several cardiovascular risk factors in patients with both MetSyn and type 2 DM. These effects might partly offset the excess cardiovascular risk and improve outcome in this patient population