Obesity and carbohydrate metabolism

Autorzy artykułu przedstawili problem narastającej otyłości i zachorowań na cukrzycę typu 2 w końcu XX i na początku XXI wieku. W niniejszej pracy omówiono przyczyny otyłości, wpływ czynników genetycznych i środowiskowych oraz podkreślono rolę centralnej otyłości w rozwoju cukrzycy i choroby niedokrwiennej serca.We evaluate the global epidemic of obesity and type 2 diabetes mellitus in the 20th and the early 21 century. We take into the consideration the genetic and environmental factors and their role in the developing of obesity. We underline the role of central obesity in the pathogenesis of type 2 diabetes and coronary heart disease

Markery ryzyka rozwoju cukrzycy typu 1 u krewnych I stopnia osób chorych na cukrzycę typu 1

Introduction: The aim of this study was to evaluate beta-cell function and insulin resistance in relation to the occurrence of anti-islet antibodies in first degree relatives of patients with type 1 diabetes (T1D).Material and methods: The group studied consisted of 90 relatives and 60 healthy individuals without a family history of diabetes. An intravenous glucose tolerance test (IVGTT) was performed in all participants and the first phase insulin response index (FPIR) was calculated. Serum concentrations of GADA, IAA and IA-2A were measured by RIA. HOMA-IR and HOMA%B indices were calculated usinga computer calculator from website.Results: At least one positive antibody was found in 28 relatives (31.1%) but in none of the controls. The most frequently detected antibodieswere IAA (22.2%). The relatives of diabetic patients had significantly higher fasting insulin level (p), significantly lower FPIR index(p), as well as higher HOMA-IR (p) and lower HOMA%B (p) compared to the controls. A positive correlation between IAA concentration and HOMA-IR (r = 0.287, p < 0.005) and a negative correlation between IAA level and HOMA%B (r = –0.226, p < 0.05) were also shown.Conclusions: Our results confirmed that more than 30% of the first-degree relatives of diabetic patients have positive markers of autoimmunebeta-cell destruction. The study showed also that these individuals, in spite of normal glucose tolerance, have markedly decreased beta-cell secretory reserve and decreased sensitivity to insulin action, strongly suggesting an increased risk for developing diabetes laterin life.Wstęp: Celem pracy była ocena funkcji komórek beta i wrażliwości na insulinę w zależności od obecności przeciwciał skierowanych przeciwko antygenom wysp trzustkowych, u krewnych I stopnia osób chorych na cukrzycę typu 1 (T1D).Materiał i metody: Grupę badaną stanowiło 90 krewnych I stopnia oraz 60 osób z ujemnym wywiadem rodzinnym w kierunku cukrzycy (grupa kontrolna). U wszystkich badanych dokonano pomiaru przeciwciał GADA, IAA i IA-2A (RIA), a następnie wykonano dożylny test tolerancji glukozy z oceną pierwszej fazy wydzielania insuliny oraz obliczono wskaźniki HOMA-IR i HOMA%B.Wyniki: Podwyższone stężenie przynajmniej jednego przeciwciała stwierdzono u 28 krewnych (31,1%), przy czym najwyższy odsetek dotyczył przeciwciał IAA (22,2%). Obecności przeciwciał przeciwwyspowych nie obserwowano w grupie kontrolnej. W grupie krewnych wykazano ponadto istotnie wyższe stężenie insuliny na czczo (p < 0,005), istotnie obniżony wskaźnik pierwszej fazy wydzielania insuliny (p < 0,005), jak również znamiennie wyższy wskaźnik HOMA-IR (p < 0,005) i niższy wskaźnik HOMA%B (p < 0,05) w porównaniu z grupą kontrolną. Stwierdzono także dodatnią korelację pomiędzy stężeniem IAA i HOMA-IR (r = 0,287, p < 0,005) oraz ujemną pomiędzy stężeniem IAA i HOMA%B (r = –0,226, p < 0,05).Wnioski: Wyniki potwierdzają obecność markerów autoimmunologicznej destrukcji komórek beta u ponad jednej trzeciej krewnych pacjentów z cukrzycą typu 1. Krewni I stopnia, pomimo prawidłowej tolerancji glukozy, charakteryzują się zaburzeniami pierwszej fazy wydzielania insuliny oraz zmniejszoną wrażliwością na insulinę, co może wskazywać na podwyższone ryzyko rozwoju cukrzycy typu 1 w przyszłości

The C-peptide as a risk factor of development of type 1 diabetes in the first degree relatives of the autoimmunological diabetic patients

Wstęp: Osoby z wysokim ryzykiem rozwoju cukrzycy typu 1, do których zalicza się krewnych I stopnia, mogą posiadać we krwi charakterystyczne dla cukrzycy autoimmunologicznej markery immunologiczne i/lub metaboliczne, i/lub genetyczne. Ich obecność zwiększa ryzyko rozwoju klinicznych objawów choroby. Celem niniejszej pracy była ocena wielkości stężenia peptydu C w zależności od występowania markerów immunologicznych (anty- GAD, IAA i anty-IA2) oraz przydatności tego parametru w ocenie ryzyka rozwoju cukrzycy typu 1 w grupie krewnych I stopnia osób chorych na cukrzycę autoimmunologiczną. Materiał i metody: Badania przeprowadzono u 90 krewnych I stopnia, w wieku 13-65 lat (śr. wieku 33,1 &#177; 15,48 roku) i ze średnim BMI 24,6 &#177; 4,95 kg/m2 (17-38 kg/m2). Stężenie peptydu C na czczo oznaczono metodą ELISA, a miana anty-GAD i IAA oraz anty-IA2 metodą RIA. Wyniki: U żadnej osoby nie zaobserwowano obniżonych stężeń peptydu C na czczo, natomiast u 22 badanych (24,44%) odnotowano podwyższone jego wartości (> 2,9 ng/ml). Spośród nich, u 7 krewnych (31,8%) wykazano obecność przynajmniej jednego przeciwciała. Zaobserwowano też dodatnią korelację pomiędzy stężeniem peptydu C i IAA (r = 0,282; p < 0,002). U żadnej osoby badanej nie rozwinęła się pełnoobjawowa cukrzyca typu 1. Wnioski: Wzrost stężenia peptydu C na czczo może świadczyć o kompensacyjnym wzroście czynności wydzielniczej komórek b trzustki w badanej grupie krewnych I stopnia i pośrednio może dowodzić istnienia insulinooporności u tych osób. Obecność podwyższonego stężenia peptydu C oraz dodatniego miana przeciwciał IAA, przy braku klinicznych objawów cukrzycy typu 1, wydaje się stanowić czynnik prognostyczny mogący opóźniać ujawnienie się klinicznych objawów choroby.Introduction: People with a high risk of development of type 1 diabetes, like first degree relatives, have characteristics for diabetes immunological/ or metabolic/or genetic markers. Presence of these markers in the blood increase the risk of development of clinically symptoms of the disease. The aim of the study was to evaluate the fasting level of the C-peptide, depending on immunological markers presence (anti-GAD, IAA and anti-IA2 antibodies) and usefulness of this parameter in the risk assessment of development of type 1 diabetes in the first degree relatives of autoimmunological diabetic patients. Material and methods: The study was carried out in the group of 90 relatives in age from 13 to 65 (an average of age 33.1 &#177; 15.48 years old) and an average BMI 24.6 &#177; 4.95 kg/m2 (17-38 kg/m2). The fasting level of C-peptide was marked by ELISA method, anti-GAD, IAA, anti-IA2 antibodies titres by RIA method. Results: Lowered level of the C-peptide secretion was not observed in our study. In 22 persons (24.44%) increased of the fasting C-peptide secretion was assessed (> 2.9 ng/ml). Within this group, 7 relatives (31.8%) was positive titre of at least one of antibodies. We observed the positive correlation between C-peptide secretion and IAA (r = 0.282; p < 0.002). Until present moment no clinical symptoms of diabetes were observed in none of the persons. Conclusions: The increase of fasting level of C-peptide can indicate compensatory increase of &#946; cell secretion. It can indirectly prove the presence of insulin resistance in this group of people. The presence of higher level of C-peptide and positive IAA titre with no clinical symptoms of type 1 diabetes, seems to be the prognostic factor to retard of clinical symptoms of diabetes

Could Oxidative Stress Play a Role in the Development and Clinical Management of Differentiated Thyroid Cancer?

Increased oxidative stress (OS) has been implicated as a relevant risk factor for cancer progression. Furthermore, patients diagnosed with differentiated thyroid cancer (DTC) have been characterized by an increased OS status. Therefore, assessing OS status could potentially be considered a useful tool in DTC clinical management. This measurement could be particularly valuable in personalizing treatment protocols and determining new potential medical targets to improve commonly used therapies. A literature review was conducted to gather new information on DTC clinical management, with a particular focus on evaluating the clinical utility of OS. These meta-analyses concentrate on novel approaches that employ the measurement of oxidative-antioxidant status, which could represent the most promising area for implementing clinical management

Enhanced Salivary and General Oxidative Stress in Hashimoto’s Thyroiditis Women in Euthyreosis

Hashimoto&rsquo;s thyroiditis (HT) is one of the most common autoimmune diseases. Although HT is inextricably linked to oxidative stress, there have been no studies assessing salivary redox homeostasis or salivary gland function in patients with HT. This study is the first to compare antioxidant defense and oxidative stress biomarkers in non-stimulated (NWS) and stimulated (SWS) whole saliva and plasma/erythrocytes of HT patients compared to controls. The study included 45 women with HT in the euthyreosis period as well as an age- and gender-matched control group. We showed that NWS secretion was significantly lower in HT patients compared to healthy controls, similar to salivary amylase activity in NWS and SWS. Catalase and peroxidase activities were considerably higher in NWS and SWS of HT patients, while the concentrations of reduced glutathione and uric acid were significantly lower in comparison with healthy subjects. Total antioxidant potential was significantly lower, while total oxidant status and the level of oxidation products of proteins (advanced glycation end products, advanced oxidation protein products) and lipids (malondialdehyde, lipid hydroperoxides) were significantly higher in NWS, SWS and plasma of HT patients. In conclusion, in both salivary glands of women with HT in euthyreosis, the ability to maintain redox homeostasis was hindered. In HT patients we observed oxidative damage to salivary proteins and lipids; thus, some biomarkers of oxidative stress may present a potential diagnostic value

The Changes in the Endothelial Function and Haemostatic and Inflammatory Parameters in Subclinical and Overt Hyperthyroidism

Introduction. The aim of the present study was to compare the levels of circulating markers of endothelial function and low-grade inflammation in patients with subclinical and overt hyperthyroidism (OH) due to Graves disease (GD) and toxic nodular goiter (TNG). Material and Methods. The group studied consisted of 42 patients with GD, 75 patients with TNG, and 39 healthy controls. Results. Circulating markers of endothelial dysfunction were elevated in the patients with both SH and OH, but the concentrations of interleukin-12 (IL-12) (P < 0.05), IL-18 (P < 0.05), fibrinogen (P < 0.01), and von Willebrand factor (vWF) (P < 0.05) were significantly higher in the OH than in the SH group. The highest levels of IL-6, IL-12, IL-18, vWF, sVCAM-1, and fibrinogen were found in the patients with GD, but the differences between the GD, and TNG groups were not significant. In the subjects with OH serum IL-6 was positively associated with FT3 (R = 0.276, P < 0.05), FT4 (R = 0.273, P < 0.05), and thyroid peroxidase antibodies (R = 0.346, P < 0.01) levels. Conclusion. Our results may suggest that both SH and OH may be associated with endothelial dysfunction, which is reflected by decreased fibrinolytic activity, hypercoagulability, and increased levels of IL-6, IL-12, and IL-18 and depends not only on the cause but also on the degree of hyperthyroidism

Efficacy of 99mTc-DTPA SPECT/CT in diagnosing Orbitopathy in graves’ disease

Abstract Background The most frequently used methods of assessing Graves’ orbithopathy (GO) include: Clinical Activity Score (CAS), ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI). There exists another, slightly forgotten, imaging method: single-photon emission computed tomography (SPECT) with the use of diethylenetriaminepentaacetic acid tagged with 99mTc (99mTc-DTPA). These days it is possible to conduct a SPECT examination fused with a CT scan (SPECT/CT), which increases the diagnostic value of the investigation. The aim of this paper is to evaluate the usefulness of 99mTc-DTPA SPECT/CT in diagnosing Graves orbitopathy, as compared with other methods. Methods Twenty-three patients with suspected active (infiltrative-edematous) Graves’ orbithopathy were included in the study. Each patient underwent a CAS, an MRI, and a SPECT/CT. The obtained results were analysed statistically, with the assumed statistical significance of p < 0.05. Results The SPECT/CT and MRI were found to have the highest sensitivity: 0.93 each. The SPECT/CT had the highest specificity: 0.89. MRI and CAS had lower values: 0.78 and 0.56, respectively. The occurrence of an active form of GO had no impact on the exacerbation of exophthalmos or the thickness of the oculomotor muscles. Conclusions The 99mTc-DTPA SPECT/CT method provides a very good tool for assessing the active form of GO and can, alongside the MRI scan, be used as a referential diagnostic procedure in GO

Hypercalcaemic crisis due to parathyroid adenoma of atypical location

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High Serum IgG4 Concentrations in Patients with Hashimoto’s Thyroiditis

Purpose. Since recent reports suggest that Hashimoto thyroiditis (HT) may be associated with IgG4-related disease, we aimed to find out whether the measurement of serum IgG4 allows for the identification of distinct types of HT, with different clinical, sonographic, and serologic characteristics. Methods. The group studied consisted of 53 patients with HT and 28 healthy individuals who underwent thyroid ultrasonography and body composition analysis. Serum concentrations of IgG4, TSH, anti-peroxidase antibodies (TPOAb), anti-TSH receptor antibodies, TNF-α, TGF-β1, Fas Ligand, TRAIL, and chemokines (CXCL9, CXCL11, and CXCL10) were measured by ELISA or radioimmunoassay. Results. The group with IgG4 level >135 IU/ml accounted for 32.5% of the patients. The signs of fibrosis were present in 27.0% of the high-IgG4 patients and in 9.1% of the normal-IgG4 group. The patients with elevated IgG4 required higher doses of L-thyroxine and had significantly lower level of TPOAb (P=0.02) than the non-IgG4-HT individuals and higher TNF-α level in comparison with the controls (P=0.01). Conclusions. Our results suggest that the measurement of serum IgG4 allows for an identification of patients with more rapid progression of HT, requiring higher doses of L-thyroxine. Low TPOAb level and the absence of coexisting autoimmune diseases may suggest distinct pathomechanism of this type of thyroiditis

The Relationship between Oxidative Status and Radioiodine Treatment Qualification among Papillary Thyroid Cancer Patients

Total oxidative status (TOS), total antioxidant capacity (TAC), tumor protein 53 (p53), nuclear factor kappa B (NF-κB), forkhead box protein O1 (FOXO), and sirtuin 1 (SIRT1) play crucial roles in oxidative homeostasis and the progression of papillary thyroid cancer (PTC), as previously demonstrated in the literature. Therefore, profiling these markers among PTC patients may be useful in determining their eligibility for radioiodine (RAI) treatment. Since treatment indications are based on multiple and dynamic recommendations, additional criteria for adjuvant RAI therapy are still needed. In our study, we evaluated the TOS, TAC, and serum concentrations of p53, NF-κB, FOXO, and SIRT1 to analyze the relationship between oxidative status and qualification for RAI treatment. For the purpose of this study, we enrolled 60 patients with PTC allocated for RAI treatment as the study group and 25 very low-risk PTC patients not allocated for RAI treatment as a reference group. The serum TOS and SIRT1 concentrations were significantly higher in the study group compared to the reference group (both p p < 0.05). We also demonstrated the diagnostic utility of TAC (AUC = 0.987), FOXO (AUC = 0.648), TOS (AUC = 0.664), SIRT1 (AUC = 0.709), p53 (AUC = 0.664), and NF-κB (AUC = 0.651) measurements as indications for RAI treatment based on American Thyroid Association recommendations. Our study revealed that oxidative status-related markers may become additional criteria for RAI treatment in PTC patients