Plasma adiponectin levels are related to obesity, inflammation, blood lipids and insulin in type 2 diabetic and non-diabetic Trinidadians

AIMS: To determine the relationship between plasma adiponectin levels and obesity, inflammation, blood lipids and insulin resistance in type 2 diabetics (T2DM) and non-diabetics in a patient population in Trinidad. METHODS: A cohort study of a total of 126 type 2 diabetic (42 males and 84 females) and 140 (43 males and 97 females) non-diabetic public clinic attendees were assessed between December 2008 and July 2009. Along with clinical history and anthropometry, adiponectin, TNF-α, IL-6, CRP, lipid profile, glucose, and insulin were measured in fasting blood samples and insulin resistance (HOMA-IR) was calculated. RESULTS: Diabetics had higher (p<0.05) glucose, insulin, HOMA-IR, triglycerides (TG), VLDL and systolic blood pressure than non-diabetics, but lower (p<0.05) HDL and adiponectin levels. Adiponectin levels were lower (p<0.05) in obese than in non-obese individuals regardless of diabetic status. There were significant gender differences in HDL, LDL and TG. Among non-obese persons, adiponectin correlated negatively with triglycerides (r=-0.280; adiponectin), IL-6 (r=-0.216; p<0.005), HOMA-IR (r=-0.373; p=000) and positively correlated with HDL (r=0.355; p=0.000). Diabetic status (p=0.025), TNF-α (p=0.048) and BMI (p=0.027) were identified as useful predictors of adiponectin by multiple linear regression methods. In addition binary logistic regression analysis found glucose (p=0.001) and adiponectin (p=0.047) to be useful indicators of type 2 diabetes. CONCLUSIONS: Adiponectin decreases with increasing adiposity and insulin resistance. Adiponectin and TNF-α appear to be related to differences in the insulin mediated glucose turnover.

Docosahexaenoic acid is selectively enriched in plasma phospholipids during pregnancy in Trinidadian women - Results of a pilot study

The fetal demand for docosahexaenoic acid (DHA) has to be satisfied by the mother. We determined the fatty acids in maternal plasma non-esterified fatty acid (NEFA), triacylglycerol (TAG) and phosphatidylcholine (PC), in a cross-sectional study of non-pregnant (n = 10), pregnant (n = 19), and postpartum (n = 9) women. There were lipid class-dependent differences in plasma polyunsaturated fatty acid (PUFA) concentrations between groups. During pregnancy, DHA was most highly enriched in PC, about 230 percent, with more modest enrichment for linoleic acid (LA) and arachidonic acid (AA), and no enrichment of alpha-linolenic acid (-LNA). There was relative enrichment of LA, AA and -LNA in TAG, but not of DHA. There was no specific enrichment of any PUFA in the NEFA pool. These data accord with the suggestion that the enrichment of -LNA in TAG and of DHA in phospholipids reflects hepatic regulation of n-3 PUFA metabolism which potentially enhances the delivery of DHA to the placenta.

Factor VIII:C activity in cryoprecipitate prepared at the Blood Bank, University Hospital of the West Indies, Jamaica - abstract

Cryoprecipitate is the blood product rich in factor VIII: C activity used in the treatment of haemophhlia A. The University Hospital Blood Bank makes most of this product used in Jamaica. Commercially prepared factor VIII concentrates are expensive. We examined the effect of donor variables and techniques of preparation on the potency of cryoprecipitates in order to determine the most efficient production method. Factor VIII: C activity of cryoprecipitate was measured using the activated partial thromboplastin time with a normal plasma pool being used as reference plasma. Donor age and method of freezing the plasma had no effect on potency. Blood group B had a higher yield of factor VIII: C than groups A and O. Potency was decreased by prolonged storage of blood prior to processing (p = 0.015) but was increased by increasing volumes of cryprecipitate (p<0.01). The mean potency of the factor VIII: C was 184 i.u., surprisingly higher than the usually assumed 70 i.u. used for calculating the requirements of our haemophiliacs. We recommend that plasma from fresh tested blood, frozen in - 40§C be used for preparing cryoprecipitate and that a higher value than 70 i.u. of factor VIII: C be used for each bag of cryoprecipitate (AU)

Hyperfibrinogenemia and hyperviscous plasma in hypertensive Africans

Changes in plasma fibrinogen concentrations (PFC) and relative plasma viscosity (RPV) were investigated in 61 Nigerian Africans while they were being treated for essential hypertension. The association of these hemorhelogic variables with blood pressure was examined. An analogous study was done on 30 normotensive controls for comparison. The hypertensive patients had, overall, a significant increase in both PFC and RPV (p<0.001) as compared with control values. However, 44.3 percent of the hypertensive patients had PFC and RPV values within the defined normal limits. This indicates that in a proportion of the hypertensive, treatment notwithstanding, PFC and RPV are altered only within the physiologic limits.(AU)

Profile of plasma and erythrocyte enzymes: whole blood 2, 3 bisphosphoglyceric acid and reduced glutathione levels in Jamaican diabetics - abstract

The metabolism of normal red cell is well adapted to protect itself from oxidative stress. The maintenance of red cell membrane, haemoglobin and enzymes containing sulfhydryl groups (-SH groups) are dependent upon the levels of reduced glutathione (GSH). Alteration in the activities of enzymes such as glutathione reductase and glutathione peroxidase will affect the levels of GSH and consequently the red cell metabolism. Acetylcholinesterase, an SH-dependent enzyme, also increases in the red cells in diabetics and is related to membrane fluidity. The level of 2, 3- Bisphosphoglycerate (2,3-BPG) which serves an important mechanism by which the body regulates its oxygen supply from haemoglobin to meet tissue demands, also increases in chronic anaemias observed in diabetics. In the present studies the activities of plasma and erthrocyte cholinesterase, and erthrocyte glucose-6- phosphate dehydrogenase were measured in 40 diabetic patients (both IDDM and NIDDM groups). The whole blood 2, 3-BPG and GSH were also estimated in these patients. All five parameters showed significant increases in diabetic as compared to non-diabetic controls. The results could point to a potential role of G6PD 2, 3-BPG GSH and choline sterase as indicators of diabetes control (AU)

The effect of DPT inoculation on the hormonal control of glucose homeostasis in children recovered from malnutrition

The effect of a controlled stress (DPT inoculation) on the hormonal control of glucose homeostasis was investigated in children nutritionally rehabilitated from severe malnutrition. The age range of the 15 children studied was 6-26 months. Plasma insulin (INS), growth hormone (GH) and interleukin-1 (IL-1) were measured by radioimmunoassay; plasma glucose (GLU) by a glucoseoxidase method; and red cell insulin binding ( percentSB) was determined, using A-14 monoiodinated insulin. Measurements were made on two occasions: (T-O) at 10 a.m.,12 hr before DPT inoculation, and (T-36) 36 hr. after inoculation. On both occasions, 4 hr post-prandial blood samples were used, and the mean body temperature(T) on the day of the test was determined. Red cell insulin binding ( percentSB) was significantly higher at T-36 than at T-O (16.8 ñ 1.7 vs 12.1 ñ 1.2 (14), p=0.005). (Results were expressed as mean ñ SEM, numbers of paired observations in parentheses). The higher percentSB after DPT was accompanied by an increase in the number of receptor sites (S) (29.05 ñ 6.5 vs 15.6 ñ 2.5 (14),p=0.025). However, insulin receptor affinity (K x 10(9)M(-1)) was decreased 0.7 ñ 0.1 vs 1.5 ñ 0.3(14), p=0.008). There were no significant differences in the plasma levels of insulin, glucose and interleukin-1, but plasma growth hormone (æU/ml) was increased after DPT, (18.0 ñ 3.0 vs 11.5 ñ 1.2 (13), p=0.04). Body temperature (§C) was also significantly increased after DPT,(99.9 ñ 0.4 vs 98.3 ñ 0.2(14), p=0.006). The change in plasma glucose from T-O to T-36 tended to be associated with both a change in plasma insulin (p=0.06) and plasma growth hormone (p=0.07). Increased insulin binding, as one index of increased insulin sensitivity during fever, can contribute to a reduction in blood glucose. However, the elevation in plasma growth hormone cold buffer the hypoglycaemic effect of insulin, and help to maintain glucose homeostasis (AU)

Hepatic glutathione S-transferase release after multiple halothane anaesthesia

Halothane is a commonly used anaethetic in paediatric practice. However, it is thought to be hepatotoxic. This study was designed to examine the effects of both single and multiple halothane anaesthesia on liver function. Heaptic glutathione S-transferase (GST) was also examined as a possible index of acute liver damage. The study group consisted of ten children who had consumed corrosive substances. This group was subdivided into two groups, depending on the number of halothane exposures, the single and the multiple halothane group. These children were compared with a surgical (n=5) and a ketamine control group (n=5). All children were studied prospectively over a 24hr. period, and the trend of liver enzyme release following anaesthesia measured. In addition, the children in the multiple halothane group were studied longitudinally. Four children from the study group, exhibited dramatic increases in the B1 subunit of liver specific GST, 24 hours after anaethesia. Twelve studies showed an early transient rise in total plasma GST, between the end of anaesthesia and 6 hrs. after. Six studies exhibited marked secondary rise at 24 hrs. after anaesthesia. These data indicate two possible phases of liver dysfunction following halothane anaesthesia. Significant changes in the level of aminotransferases were observed in the multiple halothane group, suggesting that measurement of these liver enzymes are still useful as indices of liver dysfunction following multiple halothane exposure. Cellular antioxidant systems were also measured to examine the relationship between halothane exposure and oxidative stress. A significant increase (p<0.05) in red cell GST was noted in the multiple halothane group, indicating that these children are in fact subjected to chronic oxidant stress. Collectively, these data indicate a transient impairment of hepatocellular integrity following multiple halothane exposures, despite lack of clinical evidence of hepatotoxicity. It is recommended that children undergoing repeated halothane anaesthesia be examined carefully for possible hepatic dysfunction (AU)

Iron in malnutrition

Plasma ferritin is used extensively as a quantitative measure of the size of iron stores in both adults and children. An elevation in plasma ferritin is seen however, not only in iron overload, but also in pathological disturbances such as liver disease, inflammation and malignancies. High plasma ferritin has been found in malnutrition. The aim of this study is to determine whether or not the high ferritin in malnutrition is the result of high iron stores or of some other condition where ferritin escapes into the plasma from damaged tissue. Twenty six malnourished children admitted to the T.M.R.U. ward were injected intra-muscularly with 500 mg of the iron specific chelating agent, Desferrioxamine, and the urinary iron output over twenty four hours determined (urinary iron in response to Desferrioxamine is a good index of the size of iron stores). This test is performed at admission and at discharge, and the urinary iron related by regression analysis to whole blood haemoglobin, packed cell volume, plasma ferritin, plasma glycosylated ferritin, percent glycosylation of ferritin, plasma iron, transferrin, percent saturation of transferrin and reduced glutathione. Urinary iron correlated significantly with plasma ferritin, glycosylated ferritin, transferrin, percent saturation of transferrin, plasma iron and reduced glutathione, and was significantly higher in children with oedema than in those without. Plasma ferritin was also significantly higher in children with oedema. The extent of the binding of plasma ferritin to Concanavalin A suggests secretion into the plasma via the normal pathway and not by leakage from damaged tissue. The data suggests high iron stores and high oxidative stress in malnutrition, the implication of which are discussed (AU)

Plasma zinc levels throughout pregnancy: a study in Jamaican women, with relevant aspects of nutrition

In a prospective study plasma zinc levels were determined by atomic absorption spectrophotometry in 135 Jamaican women over a two year period. A total of 1237 such determinations were made at fixed intervals throughout pregnancy. Each patient was investigated at 15, 20, 25, 30, 35 and 38 weeks gestation, in labour, and once in the early and in the late puerperium. Zinc being an essential trace element with a wide physiological role in many aspects of metabolism, supplementary studies on the relationship between zinc, folic acid, vitamin A, dietary intake in general, taste acuity and weight gain in pregnancy were undertaken. Results show that plasma zinc levels are lowered during pregnancy, moreso during the second trimester. The levels rise significantly during labour and then fall rapidly towards normal during the puerperium. Daily dietary zinc intake was of the order of 8-10 mg/day (the RDA for pregnancy being 15 mg/day) while protein intake averaged 67 g/day (the RDA being 80-90 g/day). Average weight gain in pregnancy was 12 kg. Plasma vitamin A and red cell folate levels were within normal range in all patients, indicating that there was no state of zinc deficiency interfering with the absorption of these vitamins. Clinical observations and laboratory investigations revealed no signs of any dietary deficiency among the patients. Viewed together, all the facets of this study suggest that the pattern of fall of plasma zinc in pregnancy is a normal physiological change not related to socio-economic status, parity or age. It is concluded that the lowered plasma zinc observed in pregnancy does not reflect a state of true zinc deficiency nor even a state of inadequate dietary zinc intake; it is most likely due to the heavy demand for zinc in the developing fetal tissues and by the expanding maternal blood volume (AU)

Reference ranges for thirteen biochemical parameters in Barbadian blood donors - abstract

At the Queen Elizabeth Hospital, the reference ranges of thirteen (13) biochemical constituents in plasma where determined, using blood donors. Prior to the establishment of these reference ranges, we were using either the European or the North American reference ranges. Differences between the Barbadian population and both of these groups are expected since we have different diets and optimal nutritional standards. Significant differences were found to be present in the plasma potassium, albumin and urate levels (p<0.01). In Jmaica, it has been shown that a reversal of the usual albumin/globulin ratio is associated with the nutritional and infectious disease status of that population. The total protein and albumin ranges appear to be wide. This is not a reflection of the precision of the methods used, but may be due to the fact that we sampled a fairly large cross-section of the population, with varying dietary habits. The low potassium range need further investigation. It must, however, be mentioned that many of our patients have a plasma potassium value at the lower limits of the European and North American reference ranges without any apparent symptoms of hypokalaemia. The explanation for the low plasma potassium value may be dietary deficiency, as the traditional Barbadian diet in the lower socio-economic group is low in fresh fruits and vegetables (AU)

The use of B-thiopropionic acid for the analysis of mixtures of adrenaline and noradrenaline in plasma by the flourometric trihydroxyindole method

The use of B-thiopropionic acid for the stabilisation of the flourescence of the final solutions in the trihydroxyindole method of analysis of adrenaline and noradrenaline is described. Reliable plasma analysis with a methodological error of about ñ0.1 ng may be achieved using this thio-acid, and the Turner 111 flourometer (AU)