Serum cystatin C levels are associated with triglycerides/high-density lipoprotein cholesterol ratio in adolescent girls ages between 16-19 years old

OBJECTIVE: The pathophysiological role of cystatin C in cardiometabolic disorders is not completely explored in young population. On the other hand, together with the increase in obesity, dyslipidemia and insulin resistance (IR) are often observed even in youngsters. The aim of the study was to investigate the relationship between cystatin C and triglycerides-to-high-density lipoprotein cholesterol ratio (TG/HDL-c), as an indicator of dyslipidemia and a surrogate marker of IR in the cohort of adolescent girls ages between 16-19 years. PATIENTS AND METHODS: A total of 99 girls were included in the study. Anthropometric and biochemical parameters were provided. Associations of biochemical markers with TG/HDL-c ratio were tested using univariable and multivariable ordinal regression analysis for TG/HDL-c ratio tertiles as dependent variable. RESULTS: In univariate analysis, cystatin C levels were significantly associated with TG/HDL-c ratio (OR=1.813; 95% CI: 1.190-2.757, p=0.005). Furthermore, multivariate analysis revealed that cystatin C was an independent predictor of TG/HDL-c ratio when body mass index and high sensitivity C-reactive protein (i.e., markers that were significantly correlated with TG/HDL-c ratio in Spearman’s correlation analysis) were included in the Model. Adjusted odds for cystatin C (OR=1.621; 95% CI: 1.028-2.552, p=0.037) demonstrated that rise in cystatin C by 0.1 mg/L increased the probability for higher TG/HDL-c tertile group by 1.621 times. CONCLUSIONS: Serum cystatin C levels are associated with TG/HDL-c ratio in adolescent girls. Longitudinal studies are needed to confirm the causal relationship between cystatin C and TG/HDL-c ratio and to further explore its diagnostic and therapeutic potential in dyslipidemia and insulin resistance in young population

Predictive values of serum uric acid and Alanine-aminotransferase for fatty liver index in Montenegrin population

Alanine-aminotransferase (ALT) and uric acid cut-off levels used in non-alcoholic fatty liver disease (NAFLD) diagnosis are advised to be lowered. Due to contradictory results on the utility of both these biomarkers for NAFLD screening, we aimed to determine their cut-off levels that can be applied to Montenegrin population with the fatty liver disease. A total of 771 volunteers were enrolled. A fatty liver index (FLI) score ≥60 was used as proxy of NAFLD. The receiver operating characteristic curve analysis with the area under the curve (AUC) was used to determine the cut-off values of ALT and uric acid associated with FLI ≥60. ALT was independent predictor of FLI in both men and women, whereas serum uric acid was its independent predictor only in women. Lower cut-off levels of ALT are associated with the increased prevalence of NAFLD [i.e., ALT was 19 IU/L (AUC=0.746, sensitivity 63%, specificity 72%, P lt 0.001) in women and 22 IU/L (AUC=0.804, sensitivity 61%, specificity 95%, P lt 0.001) in men]. The cut-off value for uric acid was 274 μmol/L (AUC=0.821, sensitivity 68%, specificity 82%, P lt 0.001) in women. Lower cut-off levels of ALT in both genders, and serum uric acid in females, can be reliable predictors of the FLI

Serum soluble transferrin receptor levels are independently associated with homeostasis model assessment of insulin resistance in adolescent girls

Introduction: Markers of iron homeostasis are related to insulin resistance (IR) in adults. However, studies in children and adolescents are scarce and show contradictory results. The aim was to evaluate the potential relationship between iron status markers and IR. Additionally, no previous study has explored the mutual effect of biomarkers of iron homeostasis and inflammation (i.e. high sensitivity C-reactive protein (hsCRP)), and adipokines (i.e. retinol-binding protein 4 (RBP4)) on IR in the cohort of adolescent girls. Material and methods: A total of 60 girls age between 16 and 19 years were included in the study. Serum levels of ferritin, transferrin, soluble transferrin receptor (sTfR), hsCRP, and RBP4 were measured by immunonephelometry. Homeostasis model assessment of insulin resistance (HOMA-IR) and iron homeostasis indexes were calculated. Univariate and multivariate binary logistic regression analysis were used to investigate the possible independent associations of the examined biomarkers. Principal component analysis was used to examine their mutual effect on HOMA-IR in the studied girls. Results: Ferritin, sTfR, hsCRP and RBP4 were significant predictors for higher HOMA-IR in univariate analysis (p = 0.020, p = 0.009, p = 0.007, p = 0.003, respectively). Multivariate regression analysis after adjustment for waist circumference (WC) showed that serum sTfR levels remained positively associated with higher HOMA-IR (p = 0.044). Factorial analysis revealed that the obesity-inflammation related factor (i.e., WC and hsCRP) and adipokine- acute phase protein related factor (i.e., RBP4 and ferritin) showed significant differences between HOMA-IR < 2.5 and HOMA-IR ≥ 2.5. Conclusions: Serum sTfR levels are independently associated with HOMA-IR, whereas higher serum ferritin levels together with higher RBP4 are related to higher HOMA-IR in adolescent girls

Kardiometabolički rizik u gradske djece u Crnoj Gori - povezanost s pretilošću i spolom

Considering previously reported discrepant results in the literature, we aimed to investigate the impact of gender and overweight/obesity on cardiometabolic risk (CMR) among Montenegrin urban children. The cross-sectional study included random sample of 201 schoolchildren aged 7-12 years (64% of boys) from Podgorica. Children’s nutritional status was determined according to the International Obesity Task Force criteria. CMR was assessed using a sum of z values of the following five indicators: glucose, total cholesterol, inverted value of high-density lipoprotein cholesterol, triglycerides, and hypertension. Higher CMR was found among both overweight and obese boys compared to normal weight boys (p<0.001). The effect size of the difference in CMR between overweight and obese girls and normal weight counterparts was less prominent (p<0.05). Logistic regression analysis revealed that body mass index was independent predictor of high CMR [odds ratio (OR)=1.06; 95% confidence interval (CI)=1.02-1.10); p=0.002]. On the contrary, we found no impact of socioeconomic status, physical activity or sedentary time on CMR in the examined cohort of schoolchildren. In conclusion, both overweight and obesity even among young population are related to higher CMR and this effect is more prominent among boys as compared to girls.Imajući u vidu oprečne podatke iz literature, cilj našega istraživanja je bio ispitati utjecaj spola i pretilosti na kardiometabolički rizik (KMR) kod gradske djece u Crnoj Gori. Studija presjeka je obuhvatila slučajni uzorak od 201 učenika u dobi od 7-12 godina (64% dječaci) iz Podgorice. Nutritivni status djece procijenjen je prema kriterijima International Obesity Task Force. KMR je izračunat kao zbir z vrijednosti dobivenih zbrajanjem 5 parametara: glukoze, ukupnog kolesterola, inverzne koncentracije kolesterola u lipoproteinima visoke gustoće, triglicerida i visokog krvog tlaka. Pretili i debeli dječaci su imali veći KMR u usporedbi s normalno uhranjenim dječacima (p<0,001). Ova razlika u KMR bila je manje izražena kod pretilih i debelih djevojčica (p<0,05) u usporedbi s normalno uhranjenim djevojčicama. Logistička regresija je pokazala da je indeks tjelesne mase nezavisan prediktor povećanog KMR [OR=1,06; (95% CI=1,02-1,10), p=0,002]. Nasuprot tome, nismo utvrdili utjecaj socio-ekonomskog statusa, fizičke aktivnosti ili sedentarnog načina života na povećan KMR u ispitivanoj kohorti djece. U zaključku, postoji povezanost pretilosti i KMR čak i u dječjoj populaciji, ali je taj učinak izraženiji kod dječaka u usporedbi s djevojčicama

Serumske vrednosti mokraćne kiseline, triglicerida i ukupnog bilirubina su povezane sa Indeksom masne jetre u adolescentnoj populaciji

Objective: Given the fact that pathophysiological background of non-alcoholic fatty liver disease is not completely elucidated, we aimed to explore the relationship between dyslipidemia, inflammation and oxidative stress with hepatic steatosis index (HSI) in the cohort of adolescent population in Montenegro. Patients and Methods: A total of 136 adolescents participated in this cross-sectional study. Anthropometric and biochemical markers were provided. HSI was calculated. Associations of biochemical parameters with HSI were tested using univariable and multivariable ordinal regression analysis for HSI tertiles as dependent variable. Results: Adjusted odds for uric acid (OR=2.641, P=0.007) and for triglycerides, (OR=5.275, P=0.008) showed their highly significant positive associations with HSI. On the contrary, adjusted odds for bilirubin (OR=0.923, P=0.015), indicated its significant negative independent association with HSI. Although C-reactive protein correlated positively with HSI in univariable analysis (OR=1.962, P<0.001), it lost its independent prediction for HSI in multivariable analysis (OR=1.442, P=0.130). Conclusion: Serum uric acid, triglycerides and total bilirubin are associated with HSI in adolescents. Longitudinal studies are needed to confirm the causal relationship between mentioned biomarkers and hepatic steatosis and to further explore its diagnostic potential in NAFLD in young population.Cilj: S obzirom na činjenicu da patofiziološki aspekt nealkoholne steatoze jetre nije u potpunosti razjašnjen, cilj studije je bio da se ispita povezanost dislipidemije, inflamacije i oksidativnog stresa sa Indeksom masne jetre (IMJ) u kohorti adolescentne populacije u Crnoj Gori. Pacijenti i Metode: Ukupno 136 adolescenata je učestvovalo u studiji preseka. Antropometrijski i biohemijski marker su mereni. IMJ je izračunat. Povezanost biohemijskih parametara sa IMJ ispitana je univarijantnom i multivarijantnom ordinalnom regresionom analizom, sa tercilnim vrednostima IMJ kao zavisnom varijablom. Rezultati: Prilagođene odds vrednosti za mokraćnu kiselinu (OR=2,641, P=0,007) i trigliceride (OR=5,275, P=0,008) pokazali su visoko značajnu pozitivnu povezanost sa IMJ. Suprotno tome, prilagođene odds vrednosti za bilirubin (OR=0,923, P=0,015) pokazale su značajnu negativnu povezanost sa IMJ. Premda su vrednosti C- reaktivnog proteina pozitivno korelirale sa IMJ u univarijantnoj (OR=1,962, P<0,001), isti je izgubio nezavisnu predikciju za IMJ u multivarijantnoj analizi (OR=1,442, P=0,130). Zaključak: Serumske vrednosti mokraćne kiseline, triglicerida i ukupnog bilirubina su povezane sa IMJ u adolescenata. Longitudinalne studije su potrebne da potvrde uzročnu povezanost između pomenutih biomarkera i steatoze jetre, kao i da dalje ispitaju njihov dijagnostički potencijal za ovo oboljenje u mlađoj populaciji

Cardiovascular risk estimated by UKPDS risk engine algorithm in diabetes

Since there is a high prevalence of type 2 diabetes mellitus (DM2), as well as CVD in Montenegro, we aimed to estimate CVD risk by United Kingdom Prospective Diabetes Study (UKPDS) risk engine algorithm in individuals with DM2. Furthermore, we aimed to explore whether non-traditional biomarker such as high sensitivity C-reactive protein (hsCRP) is superior for CVD risk prediction over old traditional risk factors. A total of 180 participants with DM2 (of them 50% females) were included in the current cross-sectional study. Biochemical and anthropometric parameters, and blood pressure were obtained. More males than females were classified at high UKPDS risk category (p lt 0.001). Also, about one third of diabetic patients (29.4%) were classified into the high-risk category. In multivariate regression analysis, triglycerides [Odds ratio (OR) =1.703, p=0.001] and creatinine concentration (OR=1.040, p lt 0.001) were independent predictors of CVD risk, whereas hsCRP was not correlated with CVD risk. HsCRP is not superior for CVD risk prediction by UKPDS risk engine algorithm over high triglyceride and creatinine levels in diabetic population, which suggests that the old traditional markers must not be underestimated when examining CVD risk in population with diabetes

Predictors of Adults’ Mental Health During Initial Stage of Covid-19 Pandemic in Croatia

Besides causing serious threats to people’s physical health and lives, pandemics can lead to psychological distress. This study aimed to investigate the relationship between the COVID-19 pandemic and mental health among adults in Croatia and its association with sociodemographic factors, perceptions of pandemic, locus of control, coping with stress and perceived social support. A cross-sectional, observational study was conducted using a snowball sampling technique. The online survey collected information on sociodemographics, chronic health conditions, self-isolation measure, perception of COVID-19, mental health status, locus of control, coping with stress and perception of social support. Mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). A total of 1482 participants (252 males and 1230 females) completed the study. The mean age of the participants was 33.3 ± 12.2 years, 43 % of the participants had elevated levels of anxiety and 18 % suffered from severe and extremely severe anxiety, 33 % had elevated levels of depression and 12 % suffered from severe and extremely severe depression, and 55 % had elevated levels of stress with 13 % suffering from severe and extremely severe stress. The strongest predictors of mental health symptoms were coping with stress, locus of control, and perceived social support. These results highlight the necessity of implementing psychological interventions during the pandemic to improve the mental health of the adults and vulnerable groups in particular that should include identified factors associated with better mental health status such as coping with stress focused on problem, social diversion and social support

Menopauza kao nezavisni prediktor povišenih vrednosti retinolvezujućeg proteina 4 u serumu

Aim: Retinol-binding protein 4 (RBP4) is a novel adipokine closely related to insulin resistance. However, data on the influence of menopausal status on serum RBP4 are scarce. Therefore, the aim of the current study was to examine whether RBP4 levels are associated with menopausal status per se, independently of insulin resistance. Methods: A total of 30 premenopausal and 100 postmenopausal women non-treated with medications were included in the cross-sectional study. Anthropometric and biochemical parameters, as well as blood pressure (BP) were obtained. The homeostasis model assessment of insulin resistance (HOMA-IR) and estimated glomerular filtration rate (eGFR) were calculated. Results: Postmenopausal women displayed higher RBP4 and an unfavorable cardiometabolic profile, compared to premenopausal ones. Multiple linear regression analysis showed that in addition to high triglycerides level (beta=0.315; p=0.002), decreased eGFR (beta=-0.258; p=0.004) and high systolic BP (beta=0.418; p=0.028), menopause per se is an independent predictor of higher RBP4 levels (beta=0.240; p=0.016), (R2-adjusted=0.310; F=6,522; p lt 0.001). Conclusions: Serum RBP4 levels are dependent of menopausal status, which should be taken into account when examining the role of this adipokine in cardiometabolic diseases' occurrence.Cilj: Retinol-vezujući protein 4 (RBP4) je novi adipokin, usko povezan sa insulinskom rezistencijom. Međutim, nema dovoljno podataka u literaturi o uticaju menopauze na vrednosti ovog proteina u serumu. Zato je cilj ove studije bio da se ispita da li je povezanost menopauze i RBP4 nezavisna ili je posredovana insulinskom rezistencijom. Metode: Ukupno 30 žena u premenopauzi i 100 žena u postmenopauzi, koje nisu na terapiji su uključene u studiju preseka. Mereni su antropometrijski i biohemijski parametri, kao i krvni pritisak (KP), HOMA indeksi, procenjena jačina glomerularne filtracije (JGF) i izračunati su. Rezultati: Kod žena u postmenopauzi zabeležene su veće vrednosti RBP4 i nepovoljniji kardiometabolički profil, u poređenju sa ženama u premenopauzi. Višestruka linearnaregresiona analiza je pokazala da su više vrednosti triglicerida (beta=0,315; p=0,002), smanjena JGF (beta=-0,258; p=0,004), više vrednosti sistolnog KP (beta=0,418; p=0,028), i menopauza (beta=0,240; p=0,016), nezavisni prediktori povišenih vrednosti RBP4 u serumu (R2-adjusted=0,310; F=6,522; p lt 0,001). Zaključak: Menopauza utiče na vrednosti RBP4 u serumu, što treba uzeti u obzir prilikom ispitivanja uloge ovog adipokina u pojavi kardiometaboličkih poremećaja

Uticaj gojaznosti na serumski nivo mokraćne kiseline kod žena u postmenopauzi

Introduction: At physiological concentrations uric acid (UA) is a powerful antioxidant. However, at higher concentrations UA acts as an oxidant leading to cell damage and consequent risk for many diseases. The underlying mechanism of the relationship between higher UA level and obesityrelated diseases is not well elucidated. Therefore, the aim of the study was to determine the influence of obesity on serum UA level in postmenopausal women. Methods: A total of 100 overweight/obese postmenopausal women were included in this study. Anthropometric parameters: height, weight and waist circumference (WC) were measured, and body mass index was calculated in all participants. Biochemical parameters: uric acid, fasting glycemia, insulin resistance ((HOMA-IR) was calculated), lipid profile, cystatin C, retinol-binding protein 4 (RBP4), high sensitivity C-reactive protein were determined. Results: After dividing patients according to tertile values of UA concentration, significant increase in anthropometric measurements, HOMA-IR, cystatin C, RBP4, and blood pressure were found in the highest UA tertile. In multiple linear regression analysis, WC (Beta=0.414, p lt 0.001), and cystatin C (Beta=0.300, p lt 0.001), (R2=0.467; p lt 0.001) were the best predictors of higher UA level. Conclusion: Abdominal obesity is the imoprtant determinant of higher UA level in postmenopausal women. A better understanding of underlying mechanisms of hyperuricaemia and adipose tissue disfunction in obesity, such as dysregulation of adipokines and chronic inflammation, together with discovering new target therapy may be of paramount importantance for treating obestity complications.Cilj: U fiziološkim koncentracijama mokraćna kiselina (MK) je moćan neenzimski antioksidans. Ipak, u povišenoj koncentraciji, MK ispoljava oksidativno dejstvo, dovodeći do oštećenja ćelije sa posledičnim rizikom za nastanak brojnih oboljenja. Mehanizam putem kojeg povećana koncentracija MK dovodi do oboljenja uzrokovanih gojaznošću nije u potpunosti razjašnjen. Zato je cilj naše studije da se ispita uticaj gojaznosti na serumski nivo MK kod žena u postmenopauzi. Metode: U ovom istraživanju je bilo uključeno 100 predgojaznih/gojaznih žena u postmenopauzi. Svim ispitanicama su izvršena antropometrijska merenja, koja su obuhvatila merenje telesne visine, telesne mase i obima struka. Indeks telesne mase je izračunat. Određivani su sledeći biohemijski parametri: MK, glikemija, (insulinska rezistencija [HOMA-IR]), lipidni status, cistatin C, retinol - vezujući protein (RBP4) i visokosenzitivni C-reaktivni protein. Rezultati: Podelom MK na tercilne vrednosti, uočene su najveće vrednosti antropometrijskih parametara, HOMA-IR, RBP4, cistatina C i krvnog pritiska u grupi sa najvišim vrednostima MK. Primenom višestruke linearne regresije, najveći uticaj na varijabilitet MK pokazao je obim struka (Beta=0,414; p lt 0,001), zatim cistatin C (Beta=0,300; p lt 0,001), (R2=0,467; p lt 0,001). Zaključak: Abdominalna gojaznost je važna determinanta povišenih vrednosti MK kod žena u postmenopauzi. Bolje razumevanje mehanizama koji dovode do hiperurikemije i disfunkcije masnog tkiva u gojaznosti, kao što su poremećena regulacija adipocitokina i hronična inflamacija, te otkrivanje dodatnih terapijskih ciljeva, može biti od velikog značaja u lečenju komplikacija gojaznosti

Da li je endokan novi potencijalni biomarker za steatozu i fibrozu jetre?

Studies that evaluated endocan levels in nonalcoholic fatty liver disease (NAFLD) and liver fibrosis are scarce. We aimed to explore endocan levels in relation to different stages of liver diseases, such as NAFLD, as determined with fatty liver index (FLI) and liver fibrosis, as assessed with BARD score. A total of 147 participants with FLI≥60 were compared with 64 participants with FLI <30. An FLI score was calculated using waist circumference, body mass index, gamma-glutamyl transferase and triglycerides. Patients with FLI≥60 were further divided into those with no/mild fibrosis (BARD score 0-1 point; n=23) and advanced fibrosis (BARD score 2-4 points; n=124). BARD score was calculated as follows: diabetes mellitus (1 point) + body mass index≥28 kg/m2 (1 point) + aspartate amino transferase/alanine aminotransferase ratio≥0.8 (2 points). Endocan was independent predictor for FLI and BARD score, both in univariate [OR=1.255 (95% CI= 1.104-1.426), P=0.001; OR=1.208 (95% CI=1.029- 1.419), P=0.021, respectively] and multivariate binary logistic regression analysis [OR=1.287 (95% CI=1.055- 1.570), P=0.013; OR=1.226 (95% CI=1.022-1.470), P=0.028, respectively]. Endocan as a single predictor showed poor discriminatory capability for steatosis/fibrosis [AUC=0.648; (95% CI=0.568-0.727), P=0.002; AUC= 0.667 (95% CI=0.555-0.778), P=0.013, respectively], whereas in a Model, endocan showed an excellent clinical accuracy [AUC=0.930; (95% CI=0.886-0.975), P<0.001, AUC=0.840 (95% CI=0.763-0.918), P<0.001, respectively]. Endocan independently correlated with both FLI and BARD score. However, when tested in models (with other biomarkers), endocan showed better discriminatory ability for liver steatosis/fibrosis, instead of its usage as a single biomarkerUvod: Nema mnogo studija koje su ispitivale vrednosti endokana kod obolelih od nealkoholne steatoze i fibroze jetre. Naš cilj je bio da se ispita nivo endokana u različitim stadijumima oboljenja jetre, kao što su nealkoholna steatoza jetre, predstavljena indeksom masne jetre (FLI) i fibroza jetre, predstavljena BARD skorom. Metode: Ukupno 147 učesnika sa FLI≥60 poređeno je sa 64 učesnika sa FLI <30. FLI skor je izračunat koriste i vrednosti obim struka, indeksa telesne mase, aktivnosti gama-glutamil transferaze i vrednosti triglicerida. Ispitanici sa FLI≥60 su dalje podeljeni u 2 grupe: bez fibroze/blaga fibroza (BARD skor 0–1 poen; n=23) i uznapredovala fibroza (BARD skor 2–4 poena; n=124). BARD skor je računat na sledeći način: e erna bolest (1 poen) + indeks telesne mase≥28 kg/m2 (1 poen) + odnos aspartat aminotransferaza/alanin aminotransferaza≥0,8 (2 poena). Rezultati: Endokan je nezavisan prediktor FLI i BARD skora, kako u univarijantnoj [OR=1,255 (95% CI=1,104– 1,426), P=0,001; odnosno OR=1,208 (95% CI=1,029– 1,419), P=0,021], tako i u multivarijantnoj binarnoj logističkoj regresionoj analizi [OR=1.287 (95% CI=1,055– 1,570), P=0,013; odnosno OR=1,226 (95% CI=1,022– 1,470), P=0,028]. Endokan kao samostalan prediktor pokazao je slabu diskriminatornu mo za steatozu/fibrozu jetre [AUC=0,648; (95% CI=0,568–0,727), P=0,002; odnosno AUC=0,667 (95% CI=0,555–0,778), P=0,013], ali je u Modelu pokazao odličnu kliničku tačnost [AUC=0,930; (95% CI=0,886–0,975), P<0,001; odnosno AUC=0,840 (95% CI=0,763–0,918), P<0,001]. Zaključak: Endokan je nezavisno povezan kako sa FLI, tako i sa BARD skorom. Ipak, u modelu (sa drugim biomarkerima), endokan je pokazao bolju diskriminatornu sposobnost za steatozu/fibrozu jetre