Metabolic syndrome, adipokines and sex hormone concentrations in middle-aged women

The incidence of metabolic syndrome (MetS) increases with age, something which is more noticeable in women, particularly perimenopausal women. Weight gain and the development of abdominal obesity are considered to be the main cause of increased risk of MetS and cardiometabolic factors in perimenopausal women. Increased visceral adipose tissue correlates with elevated insulin resistance, inflammation, hypertension and hyperlipidaemia in middle-aged women. In recent years, particular attention has been drawn to the endocrine role of adipose tissue, mainly visceral adipose tissue, and the concentrations of adipokines and inflammation markers such as: leptin, adiponectin, free fatty acids, adipocyte fatty acid binding protein, C-reactive protein (CRP), and inflammatory cytokines. The development of abdominal obesity is mostly associated with a loss of the protective role of oestrogens and a relative increase of circulating androgens. After menopause, the adipose tissue serves as the primary source of oestrogen production via aromatisation that converts androstenedione and testosterone to oestrone and 17b-oestradiol (E2), respectively. Studies looking at the relation between menopause and MetS conducted over the past years have mostly focused on the analysis of such hormone balance parameters as: E2, free oestradiol, oestrone and androgenic indicators: total testosterone, free testosterone, sex hormone binding globulin or dehydroepiandrosterone sulfate. In most cases, the results of the research indicate a greater importance of androgenic markers in the assessment of MetS and cardiometabolic risk factors occurrence in perimenopausal and postmenopausal women

The association of vitamin D with common diseases — an appraisal of recent evidence

It has been several years since the discovery of the pleiotropic effects of vitamin D, and there is still hot debate as to the role of vitamin D and attempts to standardise methods of determining 25(OH)D concentrations as well as supplementation with vitamin D. Many studies, both observational and randomised controlled trials, have revealed a whole range of opportunities of active vitamin D metabolite contribution to the treatment of common diseases. A relationship between high concentrations of vitamin D and a low risk of incidence of colorectal cancer, cardiovascular diseases, hypertension, ischaemic stroke, depression,metabolic syndrome and type 2 diabetes has been suggested for a long time, although recently published meta-analyses have created some doubts. There is no consensus regarding vitamin D supplementation and the optimum concentration of serum 25(OH)D. The Institute of Medicine’s 2011 report recommends achieving serum 25(OH)D concentration of 20 ng/mL as optimal, at a dosage of 600 IU of vitamin D per day. International recommendations suggest for individuals at risk a dosage of vitamin D of 2,000 IU per day. Polish experts advise that the optimal concentration of 25(OH)D should be greater than 30 ng/mL for adults

Obesity phenotypes: normal-weight individuals with metabolic disorders versus metabolically healthy obese

According to recent studies, adipose tissue secretes a large number of bioactive proteins, which affect the whole body metabolism. The amount of adipose tissue is the main factor that explains metabolic disorders; however, obesity is not necessarily the result of increased body weight. Interestingly, there is a subgroup of patients with normal weight and high-risk metabolic profile. Consequently, they are significantly more likely to have metabolic disorders or cardiovascular disease (CVD). Conversely, some individuals, called metabolically healthy obese (MHO), demonstrate a favourable metabolic profile despite having high BMI index and excessive adipose tissue. The aim of this paper is to review recent studies about obesity phenotypes. Better understanding of differences between metabolically obese normal-weight (MONW) and MHO may improve the therapy and treatment of metabolic health in all obese patients. Equally importantly, it may lead to an increase in early detection of individuals with metabolic disorders, regardless of their body mass value or BMI.

Association of serum bilirubin, selected iron status indicators and body composition in non-obese, normoglycemic subjects

Background: Recently cardiometabolic risk reduction has been observed in patients with slightly elevatedbilirubin concentration, as well as increased risk in subjects with excessive iron reserves. The aim of thisstudy was to evaluate the relationship between overweight and/or abdominal obesity, serum bilirubin andselected iron status indicators levels in non-obese subjects. Methods: The study group consisted of 80 healthy, non-obese subjects aged 25–40 years. In all subjectstotal and direct bilirubin (T-BIL, D-BIL), iron (Fe), transferrin (TRSF), ferritin (FERR) and hepcidin (HEPC)measurements were performed. Anthropometric parameters (BMI, waist circumference, WHR) weremeasured and body composition (% of body fat, muscles and level of visceral fat) was evaluated usingbody segment analyzer. Results: Men showed significantly higher values of waist circumference, WHR, muscle mass, visceral fatlevel and FERR and HEPC concentrations, compared to women. Lower concentrations of T-BIL, D-BIL andhigher concentration of FERR, HEPC occurred in the overweight group. In all subjects and in the overweightgroup T-BIL, D-BIL showed negative correlations with BMI, waist circumference, fat mass and visceral fatlevel, while for FERR, HEPC those correlations were positive. Overweight subjects had an approximately4-fold higher incidence of low T-BIL, D-BIL levels (p < 0,001), as well as nearly 2-fold higher incidence ofhigh transferrin level (p = 0,02). Conclusions: Overweight subjects have lower bilirubin levels and higher levels of factors potentially contributingto increased oxidative stress, for example ferritin and hepcidin. Serum bilirubin, ferritin and hepcidinconcentration are related to body composition indicators, particullary fat mass and visceral fat level

Association of serum total bilirubin with traditional and novel cardiovascular risk factors in apparently healthy subjects

Background. Bilirubin is considered as one of the strongest endogenous antioxidants. Recent studies suggest that high total bilirubin levels are associated with lower cardiovascular disease (CVD) risk. The aim of this study was to evaluate a the relationship between serum total bilirubin and traditional as well as new risk factors for CVD in apparently healthy subjects. Materials and methods. Study included 60 non-smoking, non-obese individuals (30 females, 30 males) with normal fasting glucose, aged 25–40 years. In all subjects basic anthropometric indicators (weight, WHR, BMI), blood pressure and laboratory tests: serum total bilirubin (Bil-T), lipid profile, CRP, plasma glucose, apolipoproteins AI and B and 25-hydroxyvitamin D were performed. Subjects were divided into two groups of relative CVD risk, specified by total bilirubin levels: low-risk (≥ 13.7 μmol/L) and high-risk (< 13.7 μmol/L). Results. Total bilirubin ranged 6.16–32.15 μmol/L. In the study group 58% of subjects had Bil-T values above 13.7 μmol/L. Higher values occurred more frequently in men (70%) and in subjects aged 30–40 years (71%). Statistically significant relationship between Bil-T, and traditional and new risk factors for CVD was found. Bil-T correlated negatively with non-HDL-C, LDL-C, systolic blood pressure as well as with apoB: apoAI ratio, apolipoprotein B, TC:HDL-C and TC. A weak positive correlation was found between serum Bil-T and HDL-C. Additionally, negative correlations with CRP and positive with 25-hydroxyvitamin D were observed in women. In subjects with low CVD risk, the prevalence of low LDL-C concentration (< 2.59 mmol/L) was nearly three-fold higher compared with high-risk groups. Furthermore, in low-risk group the prevalence of serum CRP < 1 mg/L and HDL-C levels > 1.55 mmol/L was 2-fold and 3-fold higher, respectively, and higher incidence of low apoB:apoAI values (<0.6) was observed. Conclusions. Serum total bilirubin may play an important role in reducing the risk of CVD, therefore its assay seems to be valuable for more accurate assessment of cardiovascular risk in young, non-obese, non-diabetic individuals

Association of serum adiponectin and visfatin with body composition and selected biochemical cardiometabolic risk factors in non-obese individuals with normal fasting glycaemia

Background: Adipose tissue produces many metabolically active substances such as adiponectin and visfa-tin. Both have potential anti-inflammatory, anti-atherogenic, and increasing insulin sensitivity properties. We evaluated the diagnostic value of serum adiponectin and visfatin as potential cardiometabolic risk factors. Subjects and methods: Sixty non-smoking, non-obese subjects aged 25–40 years with normal fasting glycaemia were included in the study. In all subjects serum fasting lipid profile, CRP, glucose, insulin, and apolipoprotein AI and B measurements were performed on an automatic analyser, while adiponectin and visfatin were measured using manual enzyme-linked immunosorbent assay (ELISA). Blood pressure measurements, body composition analysis using bioimpedance method (BIA), and basic anthropometric measurements (weight, BMI, WHR) were performed. Results: In the study group the concentration of adiponectin and visfatin was significantly inversely and moder-ately related with the amount of visceral fat, BMI, and waist circumference, while an inverse weak relationship with HOMA-IR and insulin level was observed. Moreover, adiponectin was weakly inversely related with CRP but positively with HDL-C and apolipoprotein AI. The prevalence of subjects with CRP < 1 mg/L was signifi-cantly higher at the highest adiponectin and visfatin concentrations (third tertile). At the lowest adiponectin concentrations (first tertile) the percentage of subjects with elevated apoB ≥ 100 mg/dL was increased. Conclusion: The relationship of serum adiponectin and visfatin with the amount of visceral fat, lipid profile, apolipoproteins, and CRP suggests their potential diagnostic value in the assessment of cardiometabolic risk. The predictive value of both adipocytokines should be confirmed in a large population-based study

Osteoprotegerin, sRANKL and sRANKL /OPG ratio in pseudosynovial fluid from patients with aseptic loosening of total hip prosthesis

Background. Total hip replacement is the final solution in advanced osteoarthritis. The survival time of the implant significantly depends on the condition of the bone in which it has been located. Upsetting the balance in the RANK/RANKL/OPG system can lead to the development of bone metabolic disorders leading to bone loss. The aim of this study was to evaluate the osteoprotegerin (OPG) and soluble RANKL (sRANKL) concentrations in the pseudosynovial fluid in women with aseptic loosening of total hip prosthesis.Methods. OPG and sRANKL concentrations were assayed in the pseudosynovial fluid collected from 20 women during the revision total hip arthroplasty (THA) (group R), and in the synovial fluid of 13 women in the end-stage of idiopathic osteoarthritis collected during primary THA (group P). OPG and sRANKL were measured using commercially available ELISA kits.Results. OPG concentration was significantly lower, and sRANKL concentration was significantly higher, in group R than in group P. The sRANKL/OPG ratio in group R was significantly higher than in group P. The average total joint endoprosthesis survival time was 8.6 (SD 3.9) years. The OPG concentration was slightly lower in patients with a time interval shorter than 8.6 years. The sRANKL/OPG ratio was higher in women with a shorter implant survival time.Conclusion. Higher sRANKL/OPG ratio in the pseudosynovial fluid contributes to increased resorption of bone tissue surrounding total hip endoprosthesis, leading to its aseptic loosening

Influence of body weight on intensity of inflammation status in healthy perimenopausal and postmenopausal women

WSTĘP. Okres okołomenopauzalny i pomenopauzalny jest związany z wygasaniem funkcji jajników i zwiększonym ryzykiem wystąpienia nadwagi oraz otyłości. Obniżone stężenie hormonów płciowych oraz otyłość brzuszna mogą wpływać na nasilenie procesów zapalnych. W niniejszej pracy zbadano związek pomiędzy zaburzeniami hormonalnymi i wskaźnikami zapalnymi oraz wskaźnikami masy ciała u kobiet w okresie około- i pomenopauzalnym. MATERIAŁ I METODY. Badaniem objęto 41 zdrowych, niepalących kobiet we wczesnej fazie perimenopauzy (PERI) i 39 kobiet w okresie pomenopauzalnym (POST). W próbkach krwi oznaczono 17β-estradiol, hormon folikulotropowy (E2, FSH; Roche Diagnostics), fibrynogen i białko C-reaktywne (hsCRP; Dade Behring). Oceniono parametry antropometryczne: wskaźnik masy ciała (BMI, body mass index), obwód talii i bioder, wskaźnik talia–biodra (WHR, waist-hip ratio). WYNIKI. Znacznie wyższe wartości BMI obserwowane były u kobiet POST, w porównaniu z kobietami PERI. Wykazano istotne korelacje pomiędzy wskaźnikami masy ciała a stężeniem białka C-reaktywnego (CRP, C-reactive protein) i fibrynogenu jedynie u kobiet po menopauzie. W badaniu regresji wielokrotnej stężenie CRP i fibrynogenu niezależnie korelowało z BMI. Nie stwierdzono zależności między stężeniem E2 i FSH a wskaźnikami zapalnymi. Wartości CRP powyżej 3 mg/l występowały 4-krotnie częściej u otyłych kobiet POST w porównaniu z kobietami PERI, niezależnie od ich masy ciała. Podwyższone wartości fibrynogenu obserwowano natomiast zarówno u otyłych kobiet PERI, jak i POST. WNIOSKI. W populacji klinicznie zdrowych kobiet w okresie pomenopauzalnym nasilenie stanu zapalnego jest uzależnione przede wszystkim od masy ciała i rozmieszczenia tkanki tłuszczowej, nie zależy natomiast bezpośrednio od stężenia hormonów płciowych.INTRODUCTION. Perimenopause and postmenopause are associated with cessation of ovarian function and increased risk of overweight and obesity. Sex hormone deficiency as well as abdominal obesity may influence inflammatory status. We investigated the relationship between hormonal status and inflammatory and body mass markers in women during menopausal transition. MATERIAL AND METHODS. Study included 41 early perimenopausal (PERI) and 39 postmenopausal (POST) healthy nonsmoking women. Blood was assayed for 17ß-estradiol, and follicle-stimulating hormone (E2, FSH; Roche Diagnostics), fibrinogen and C-reactive protein (hsCRP; Dade Behring). Anthropometric parameters (body mass index [BMI], waist, hip circumference, waist to hip ratio [WHR]) were measured. RESULTS. Markedly higher values of BMI were found in POST women compared with the PERI group. Significant correlations between markers of obesity and levels of CRP and fibrinogen were found in POST women. In multiple regression analysis, CRP and fibrinogen independently correlated with BMI. No relations between markers of inflammation and E2 or FSH were observed. Values of CRP above 3 mg/l were observed fourfold more frequently in obese POST, comparing to PERI women independently on their body weight. Increased values of fibrinogen were found in obese PERI as well as in obese POST women. CONCLUSIONS. Intensity of inflammation status seems to be related mainly to BMI and distribution of adipose tissue. Changes in the concentrations of sex hormones at the menopausal transition did not directly influence the inflammation state in clinically healthy women

Renal tubulointerstitial tissue damage, central pressure and vascular function in patients with untreated primary arterial hypertension

Background The aim of the study was to examine the correlation of the conventional method of arterial pressure measurement in the brachial artery and non-invasive aortic pressure measurement by applanation tonometry with vascular and left ventricular structure and function. An attempt was made at determining a correlation of morphological and functional changes within the cardiovascular system with selected parameters of renal filtration function and the renal interstitium in patients with previously untreated primary arterial hypertension.Material and methods 25 patients with untreated primary arterial hypertension without albuminuria and 15 healthy volunteers underwent arterial pressure measurement with a standard mercury sphygmomanometer using the Korotkoff technique and non-invasive measurement of aortic pressure by applanation tonometry using a SphygmoCor device. For all subjects, the concentrations of creatinine, uric acid, 1,25(OH)2D3, erythropoietin, and 25-hour NAG excretion were determined and GFR was estimated using the MDRD equation. PWV measurement was performed using a SphygmoCor device, whereas IMT was measured by ultrasound.Results Hypertensive patients showed higher values of arterial pressure compared to the control group: SBP, DBP, PP, MAP, as well as CSP, CDP, CPP and MCAP. In both the studied and the control group, the following statistically significant positive correlations were found: CPP vs IMT and CPP vs AIx. Only in the studied group, the following positive linear correlations were found: NAG vs PWV (R = 0.46; p = 0.019); NAG vs IMT (R = 0.36; p = 0.078). In the multiple regression model, a statistically significant positive effect was found of PWV and IMT [PWV (b 0.41; p = 0.0158), IMT (b 0.49; p = 0.0048)] on the dependent variable NAG (R2 = 0.503) in hypertensive patients. eGFR or uric acid concentration in serum included additionally in the model had no statistically significant effect on the dependent variable NAG (p = 0.9307 and p = 0.4938, respectively).Conclusions Damage to the renal tubulointerstitial tissue in hypertensive patients is concomitant with a decrease in vascular resistance. CPP may constitute a useful parameter for assessing the development of atherosclerotic lesions in vessels and the function of the left ventricle of the heart.Background The aim of the study was to examine the correlation of the conventional method of arterial pressure measurement in the brachial artery and non-invasive aortic pressure measurement by applanation tonometry with vascular and left ventricular structure and function. An attempt was made at determining a correlation of morphological and functional changes within the cardiovascular system with selected parameters of renal filtration function and the renal interstitium in patients with previously untreated primary arterial hypertension.Material and methods 25 patients with untreated primary arterial hypertension without albuminuria and 15 healthy volunteers underwent arterial pressure measurement with a standard mercury sphygmomanometer using the Korotkoff technique and non-invasive measurement of aortic pressure by applanation tonometry using a SphygmoCor device. For all subjects, the concentrations of creatinine, uric acid, 1,25(OH)2D3, erythropoietin, and 25-hour NAG excretion were determined and GFR was estimated using the MDRD equation. PWV measurement was performed using a SphygmoCor device, whereas IMT was measured by ultrasound.Results Hypertensive patients showed higher values of arterial pressure compared to the control group: SBP, DBP, PP, MAP, as well as CSP, CDP, CPP and MCAP. In both the studied and the control group, the following statistically significant positive correlations were found: CPP vs IMT and CPP vs AIx. Only in the studied group, the following positive linear correlations were found: NAG vs PWV (R = 0.46; p = 0.019); NAG vs IMT (R = 0.36; p = 0.078). In the multiple regression model, a statistically significant positive effect was found of PWV and IMT [PWV (b 0.41; p = 0.0158), IMT (b 0.49; p = 0.0048)] on the dependent variable NAG (R2 = 0.503) in hypertensive patients. eGFR or uric acid concentration in serum included additionally in the model had no statistically significant effect on the dependent variable NAG (p = 0.9307 and p = 0.4938, respectively).Conclusions Damage to the renal tubulointerstitial tissue in hypertensive patients is concomitant with a decrease in vascular resistance. CPP may constitute a useful parameter for assessing the development of atherosclerotic lesions in vessels and the function of the left ventricle of the heart