Follistatin as a Potential Biomarker for Identifying Metabolically Healthy and Unhealthy Obesity: A Cross-Sectional Study.

Metabolically healthy obesity (MHO) refers to obese individuals with a favorable metabolic profile, without severe metabolic abnormalities. This study aimed to investigate the potential of follistatin, a regulator of metabolic balance, as a biomarker to distinguish between metabolically healthy and unhealthy obesity. This cross-sectional study included 30 metabolically healthy and 32 metabolically unhealthy individuals with obesity. Blood samples were collected to measure the follistatin levels using an enzyme-linked immunosorbent assay (ELISA). While follistatin did not significantly differentiate between metabolically healthy (median 41.84 [IQR, 37.68 to 80.09]) and unhealthy (median 42.44 [IQR, 39.54 to 82.55]) individuals with obesity (p = 0.642), other biochemical markers, such as HDL cholesterol, triglycerides, C-peptide, and AST, showed significant differences between the two groups. Insulin was the most significant predictor of follistatin levels, with a coefficient of 0.903, followed by C-peptide, which exerted a negative influence at -0.624. Quantile regression analysis revealed nuanced associations between the follistatin levels and metabolic parameters in different quantiles. Although follistatin may not serve as a biomarker for identifying MHO and metabolically unhealthy obesity, understanding the underlying mechanisms that contribute to metabolic dysfunction could provide personalized strategies for managing obesity and preventing associated complications.

Effect of different alpha-receptor antagonists on metabolic parameters: a head-to-head comparison.

PURPOSE: Although it is known that alpha-adrenergic receptor antagonists have positive effects on metabolic parameters such as glucose metabolism, lipid profile, and insulin sensitivity, it is unclear whether this is a class effect. Tamsulosin is reported to have adverse effects on glucose metabolism and insulin resistance, and this may be because of its lack of glycolysis-enhancing effect compared with other alpha-adrenergic receptor antagonists with glycolysis-enhancing effects such as doxazosin, terazosin, and alfuzosin. The aim of this study was to compare the effect of tamsulosin on metabolic parameters with another alpha-1 adrenergic receptor antagonist, doxazosin. METHODS: In this prospective, observational, controlled, 12-week clinical study, a total of 60 male patients aged ≥ 40 years who were first started on tamsulosin (n = 30; 0.4 mg/day, oral; mean age, 59.20 ± 8.97 years) or doxazosin (n = 30; 4 or 8 mg/day, oral; mean age, 58.50 ± 8.93 years) for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) were enrolled. The groups were compared according to the changes in anthropometric and biochemical parameters (glycemia, lipid profile, and insulin sensitivity) at the end of treatment. RESULTS: In intragroup analyses, systolic blood pressure, diastolic blood pressure, total cholesterol, and HbA1c levels decreased significantly in the doxazosin group compared with baseline (p < 0.05 for all), while no significant change was observed in the tamsulosin group. In comparisons between groups, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels showed a significant decrease in the doxazosin group compared with the tamsulosin group (percent change: - 6.68 ± 13.08 vs. 0.53 ± 11.02, p = 0.025; - 3.63 ± 9.56 vs. 4.02 ± 10.86, p = 0.005; and - 5.62 ± 18.18 vs. 5.24 ± 15.42, p = 0.015, respectively). CONCLUSION: Although these results do not support previous findings that tamsulosin has adverse effects on metabolic parameters, they suggest that doxazosin treatment may be a reason for preference in patients with BPH or LUTS accompanied by metabolic disorder.

Is Metabolic Score for Visceral Fat (METS-VF) a Better Index Than Other Adiposity Indices for the Prediction of Visceral Adiposity.

Background: Visceral adiposity is an important risk factor for cardiometabolic diseases. Objective: To determine whether the Metabolic Score for Visceral Fat (METS-VF) is more effective than other adiposity indices in predicting visceral fat area (VFA). Methods: In this single-center and cross-sectional study, we included patients aged 20-50 years, without diabetes and coronary artery disease, who underwent computed tomography (CT) including the third lumbar vertebra. Age, blood pressure, waist circumference (WC), hip circumference, fasting lipids, and glucose were assessed. VFA was measured by cross-sectional examination of CT. The correlation of WC, body mass index (BMI), waist-hip ratio (WHR), lipid accumulation product (LAP), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), and METS-VF with VFA was analyzed by correlation analysis. The cut-off values and area under the curve (AUC) for identifying increased VFA (>130 cm2) were determined. Results: We included 185 individuals with mean age 38.2 ± 8 and female predominance (58.4%). There was a significant positive correlation between all indices and VFA (p<0.001). ROC analysis revealed that METS-VF and WC demonstrated the highest predictive value for identifying increased VFA. In both men (p=0.001) and women (p<0.001), METS-VF (AUC 0.922 and 0.939, respectively) showed a significant superiority over ABSI (AUC 0.702 and 0.658, respectively), and VAI (AUC 0.731 and 0.725, respectively). Additionally, in women, its superiority over WHR (AUC 0.807) was also statistically significant (p=0.003). We identified a METS-VF cut-off point >6.4 in males >6.5 in females and WC cut-off point >88 cm in males (AUC 0.922), >90.5 cm in females (AUC 0.938). Conclusion: METS-VF is strongly associated with visceral adiposity and better to predict increased VFA. However, its superiority over WC, BMI, BRI, and LAP was not significant. The results emphasize that WC is more appealing as screening indicator for visceral adiposity considering its easy use. Clinical Trial Registry Name: Clinicaltrials.gov (http://www.clinicaltrials.gov). Clinical Trial Registry Url: https://clinicaltrials.gov/ct2/show/NCT05648409. Clinical Trial Registry Number: NCT05648409.

A case of Mediterranean spotted fever mimicking severe sepsis.

Mediterranean spotted fever (MSF) is a tick-borne acute endemic infectious disease caused by Rickettsia conorii. While MSF may progress asymptomatically, it may lead to clinical pictures like severe hemorrhagic fever. In this article, we are presenting an MSF case with signs of high fever, headache, nausea, weakness and generalized maculopapular rash. The diagnosis of the female patient who had a history of contact with a tick-infested dog was confirmed with her clinical and laboratory data. The clinical and laboratory findings of the patient who was given doxycycline by 200 mg/day for 7 days were improved in a short time. Rickettsia conorii serology by indirect immunofluorescence assay method confirmed the diagnosis of MSF. In cases of severe sepsis accompanied by high fever and generalized maculopapular rash where the source of the infection cannot be determined in the short term, carefully questioning exposure to ticks by considering the existing geographical, seasonal and endemic environmental factors may be life-saving in terms of early diagnosis and treatment of MSF, which may become fatal even in the absence of eschars (tache noire). The symptomatology of hemorrhagic fever associated with Rickettsia conorii may be confused with that of sepsis in clinical practice.

Comparison of Initial CT Findings and CO-RADS Stage in COVID-19 Patients with PCR, Inflammation and Coagulation Parameters in Diagnostic and Prognostic Perspectives.

Objectives: This study aims to determine whether COVID-19 patients with different initial reverse transcriptase-polymerase chain reaction (RT-PCR), computed tomography (CT) and laboratory findings have different clinical outcomes. Materials and Methods: In this multi-center retrospective cohort study, 895 hospitalized patients with the diagnosis of COVID-19 were included. According to the RT-PCR positivity and presence of CT findings, the patients were divided into four groups. These groups were compared in terms of mortality and need for intensive care unit (ICU). According to the COVID-19 Reporting and Data System (CO-RADS), all patients' CT images were staged. Multivariate binary logistic regression analysis was used to examine the relationship between CO-RADS and predictive inflammation and coagulation parameters. Results: RT-PCR test positivity was 51.5%, the CT finding was 70.7%, and 49.7% of the patients were in the CO-RADS 5 stage. The need for ICU and mortality rates was higher in the group with only CT findings compared to the group with only RT-PCR positivity, (14.9% vs. 4.0%, p < 0.001; 9.3% vs. 3.3%, p > 0.05; respectively). Mortality was 3.27 times higher in patients with CO-RADS 4 compared to those with CO-RADS 1-2. Being in the CO-RADS 4 stage and LDH were discovered to be the most efficient parameters in determining mortality risk. Conclusion: Performing only the RT-PCR test in the initial evaluation of patients in SARS-CoV-2 infection may lead to overlooking groups that are more at risk for severe disease. The use of a chest CT to perform CO-RADS staging would be beneficial in terms of providing both diagnostic and prognostic information.

C-peptide concentrations in patients with type 2 diabetes treated with insulin.

AIMS: To determine beta cell reserves of patients with type 2 diabetes who are treated with insulin by using fasting C-peptide concentrations and to investigate the clinical features related to C-peptide concentrations. MATERIALS AND METHODS: Patients with type 2 diabetes, who were using insulin as monotherapy or in combination therapy, were divided into three groups; those with an insufficient beta cell reserve (C-peptide: <0.5 ng/mL), borderline reserve (C-peptide: 0.5-2 ng/mL) and sufficient reserve (C-peptide:> 2 ng/mL). RESULTS: In the 249 patients (mean age, 61.77 ± 9.34 years; 40.6% male), the mean duration of diabetes was 13.9 ± 8.43 years. The mean HbA1c concentrations, fasting glucose and C-peptide concentrations were 8.88 ± 1.87%, 184.29 ± 77.88 mg/dL and 1.95 ± 1.37 ng/mL, respectively. Fifty-seven percent of patients (n = 142) had a borderline beta cell reserve and 37% (n = 92) had high C-peptide concentrations. Only 6% of patients (n = 15) had an insufficient beta cell reserve. C-peptide levels were positively correlated with waist circumference (r: 0.282; p = 0.001), hip circumference (r: 0.251; p = 0.001), body mass index (r: 0.279; p = 0.001), fasting glucose concentrations (r: 0.309; p = 0.001) and triglyceride concentrations (r: 0.358; p = 0.001). CONCLUSION: In this study, almost all patients with type 2 diabetes using insulin were found to have sufficient or borderline beta cell reserves and insulin resistance-related parameters were prominent in those with adequate beta cell reserve. CLINICAL TRIALS NO: NCT04005261.

Gitelman Syndrome Presenting with Hypomagnesemia, Hypokalemia and Hypocalciuria: A Case Report.

Gitelman syndrome is a a rarely seen autosomal recessive renal tubulopathy characterized by inherited hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. The diagnosis of Gitelman syndrome is usually established during adolescence, but is also observed in childhood and even in the adulthood period. In this case report, we presented a 19-year-old male patient who was diagnosed as Gitelman Syndrome and admitted to the hospital with symptoms of muscle weakness, cramps and weakness.

Association between Metabolic Syndrome and Cancer.

Growing data show the association of metabolic syndrome (MetS) or its components with cancer development and cancer-related mortality. It is suggested that in MetS and cancer association, insulin resistance and insulin-like growth factor 1 system play a key role, especially adipokines secreted from visceral adipocytes, free fatty acids and aromatase activity contribute to this process. It is also reported that MetS has a link with colorectal, breast, endometrial, pancreas, primary liver and, although controversial, prostate cancer. Although every component of MetS is known to have an association with cancer development, it is still debated whether the effects of these components are additive or synergistic. On the other hand, in the association between MetS and cancer, the role of antidiabetic and antihypertensive treatments including thiazolidinedione, insulin, angiotensin receptor blockers is also suggested. The primary approach in MetS-cancer relation is to prevent risk factors. Life style changes including weight loss and a healthy diet are known to decrease cancer risk in normal population. It is postulated that an insulin-sensitizing agent, metformin, has cancer-preventing effects on diabetic patients. This review discusses the relationship between MetS and cancer from different aspects and examines this relationship in some of the cancers suggested to be linked with MetS.

Urinary kidney injury molecule-1 levels as a marker of early kidney injury in hypertensive patients.

BACKGROUND: Kidney injury molecule-1 (KIM-1) is a type 1 tubular cell transmembrane protein that is found in high levels in early stages of acute kidney injury and is stated to have predictive value in the early diagnosis of chronic kidney diseases. In this study, the hypothesis was that higher levels of KIM-1 would be detected in hypertensive patients for the early detection of nephropathy. With this goal, urinary KIM-1 levels of hypertensive cases were compared with those of healthy controls, and associations of KIM-1 levels with microalbuminuria and glomerular filtration rate (GFR) were investigated. METHODS: The study included a total of 80 patients aged ≥20 years (55 male, 25 female, mean age: 57.21±9.12 years). The patient group consisted of 40 patients (28 males, 12 females, mean age: 57.58±8.79 years) who had had hypertension for at least 5 years, and the control group consisted of 40 healthy subjects (27 female, 13 male, mean age: 56.85±9.53 years). Groups were compared based on demographic, anthropometric and biochemical data, and urinary KIM-1 levels. Correlation analysis was made to assess the association of KIM-1 levels with microalbuminuria and GFR. Levels of urinary KIM-1 enzyme were measured using linked immunosorbent assay (ELISA). RESULTS: KIM-1 levels were found to be 0.86±0.48 ng/mg creatinine in the patient, and 0.71±0.46 pg/mL in the control groups (P>0.05). A positive correlation was detected between KIM-1 levels and both systolic blood pressure and duration of disease (r=0.308, P=0.032 and r=0.339, P=0.032, respectively). CONCLUSIONS: While not supporting the hypothesis that KIM-1 levels may increase in hypertensive patients as an early indicator of hypertensive nephropathy, these findings suggested that this molecule might be associated with kidney injury in hypertensive nephropathy due to its positive correlation with the duration of hypertension.

The effect of sociodemographic and clinical features on mortality in patients with diagnosis of aspiration pneumonia.

OBJECTIVE: The aim of this study was to evaluate the sociodemographic and clinical chracteristics of patients hospitalized with aspiration pneumonia in internal medicine clinics, and to determine the incidence and parameters of mortality among these patients. METHODS: Patients over the age of 18 years who were hospitalized in clinics of internal medicine between January 1, 2010 and January 1, 2013 (115 male, 89 female; mean age: 77±13 years; patients aged 65 years and over, 88.2%; average duration of hospitalization, 11±9 days) were evaluated retrospectively and consecutively. The incidence of mortality, nutritional status at admission, comorbidity frequency, haematological and biochemical data and their relationship with mortality were evaluated. RESULTS: At admission, 85% of the patients were fed through oral route, while 15% of them were fed through PEG. There was no relation between nutritional status of the patients (oral, nasogastric tube or PEG) at admission, and development of aspiration pneumonia. Commonly seen comorbidities were dementia (49%), hypertension (43%), cerebrovascular accident (42%), and diabetes mellitus (31%) respectively. The mortality rate was 24.5% (in first three days, 56%). A correlation was found between mortality and increase in neutrophil/lymphocyte ratio (NLR) and increased uric acid rate (for both p<0.05). CONCLUSION: In this study, the mortality rates among patients diagnosed with aspiration pneumonia was found to be increased. The high number of geriatric patients and comorbidities might have played a role in this situation. Neutrophil/lymphocyte ratio (NLR) and uric acid levels in patients with aspiration pneumonia might be evaluated as factors related to mortality.

Prognosis of patients in a medical intensive care unit.

OBJECTIVE: The aim of this study is to evaluate the demographic characteristics of critically ill patients and to determine intensive care unit (ICU) mortality and its predictors. METHODS: This study was undertaken in the Istanbul Medeniyet University Göztepe Training and Research Hospital Medical ICU. Between May 2012 and January 2013, 111 patients (53 female, 58 male; mean age, 73.79±14.73, mean length of ICU length stay, 9.1±10.7; prevalence of geriatric patients, 77.5%) were admitted to the ICU. The common indications for ICU admission, prevalence of mechanical ventilation support, hematological and biochemical parameters and their effects on mortality were assessed. RESULTS: The common indications for ICU admission were hemodynamic instability (48.6%), respiratory failure (27.9%) and sepsis (15.3%). Hypertension (46.8%) was the most common comorbidity. Prevalance rates of heart failure and diabetes mellitus were 32.4% and 25.2% respectively. Mortality rate was 52.3% in all patients. Approximately 80% of all deaths was observed within the first fifteen-day. In additon, mortality rate (85.7%) was prominent within patients in need of the mechanical ventilation support. Mechanical ventilation requirement, increased ferritin and vitamin B12 levels were independent risk factors for mortality in critically ill patients (p<0.01, for all). CONCLUSION: Mortality rate was higher in medical ICU. Herein, increased prevalence of geriatric population, concomitant comorbidities and mechanical ventilation requirements may play role.

Levels of pentraxin 3 and relationship with disease activity in patients with ankylosing spondylitis.

OBJECTIVE: Ankylosing spondylitis is a chronic inflammatory disease of the sacroiliac joint and vertebral column. Pentraxin (PTX) 3 is an acute phase protein known to be associated with chronic inflammation. This study was performed to test the hypothesis that serum PTX3 levels might be elevated as a marker of inflammation in patients with ankylosing spondylitis. MATERIAL AND METHODS: A total of 73 patients older than 20 years (48 males, 25 females, mean age 32.30 ± 6.40 years) were included. The ankylosing spondilitis group consisted of 46 patients (18 females, 28 males, mean age 33.30 ± 6.12 years) diagnosed with ankylosing spondilitis by the Modified New York Criteria, and the control group consisted of 27 healthy individuals (7 females, 20 males, mean age 30.59 ± 6.62 years). Groups were compared by demographic, anthropometric, biochemical data, and by serum PTX3 levels. The ankylosing spondilitis group was also divided into 2 subgroups (active or remission) by disease activity according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and compared by serum PTX3 levels. PTX3 was measured with the enzyme linked immunosorbent method. RESULTS: PTX3 levels were higher in the ankylosing spondylitis group compared to the control group (0.29 ± 0.83 ng/mL vs. 0.09 ± 0.06 ng/mL, p=0.009). Levels of serum PTX3 were similar in groups with active and remitted ankylosing spondilitis (0.34 ± 0.99 ng/mL vs 0.37 ± 1.15 ng/mL, p>0.05). No correlation was determined between PTX3 and disease activity (p>0.05). CONCLUSION: These results are supportive of the hypothesis that levels of serum PTX 3 might be elevated in association with inflammation in patients with ankylosing spondylitis; however, results also demonstrate that there is no significant correlation with disease activity.

Apolipoprotein B assessment for evaluating lipid goals.

OBJECTIVE: It is suggested that the apolipoprotein (Apo) B levels are more valuable than LDL cholesterol (LDL-C) levels in assessing cardiovascular risk associated with hyperlipidaemia. However, although non-HDL cholesterol (non-HDL-C) levels are accepted as a secondary objective after achieving LDL-C levels in the guidelines, Apo B has not been recommended as a therapeutic goal yet. The objective of this study was to determine how many of the patients who achieved the LDL-C and non-HDL-C target recommended by the guidelines with a statin therapy achieved the Apo B target. METHODS: The study included a total of 182 consecutive hypercholesterolaemic (119 male, 63 female) patients who were over 18 years of age (mean age: 54.96 +/- 9.27 y) and on statin therapy. Apo B and non-HDL-C levels were determined for the patients who achieved or did not achieve the LDL-C target according to the cardiovascular risk categories defined in the Adult Treatment Panel-III report. Serum Apo B levels were assessed using the nephelometric method. RESULTS: The prevalence of patients who achieved the LDL-C, non-HDL-C and Apo B target was 63.2%, 79.7% and 72.5%, respectively. All of the patients who achieved the LDL-C target also achieved the non-HDL-C target. It was found that 6 of 115 patients (5.2%) who achieved the LDL-C and non-HDL-C target failed to achieve the Apo B target, whereas 23 of 132 patients (17.4%) who achieved the Apo B target failed to achieve the LDL-C target. CONCLUSIONS: These results showed that 95% of patients who received a statin therapy, and achieved LDL-C and non-HDL-C targets also achieved the Apo B target.

Control of hypertension in Turkey--is it improving? The Kocaeli 2 study.

OBJECTIVES: In a previous study conducted in Kocaeli, Turkey, ten years before, a very low rate of hypertension control (6.2%) was reported. This hypertension survey was conducted to determine whether the treatment and control rates of hypertension improved in the same region. STUDY DESIGN: Using a stratified sampling method, 1222 subjects (559 males, 663 females, mean age 44.8+/-13.6 years) living in Kocaeli, aged 25 or over, were included. After administration of a standardized questionnaire, blood pressure was measured in the sitting position from both arms after at least five minutes of resting. The measurement was repeated after 10 minutes on the arm with the higher initial reading. Hypertension was defined as the presence of a mean systolic blood pressure = or >140 mmHg and/or a mean diastolic blood pressure = or >90 mmHg, or a previous diagnosis of hypertension and/or use of antihypertensive drugs. RESULTS: The prevalence of hypertension was 33.6% (37.1% in women, and 29.5% in men, p<0.001). Of the hypertensive subjects, 59.3% were aware of their condition. Hypertension was controlled in 8.7% of the subjects (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg). CONCLUSION: Our results showed that about one-third of the adult population in Kocaeli had hypertension, with low rates of control and awareness. Since the previous survey, there has been a small improvement in hypertension control rate, but uncontrolled hypertension is still remarkably high in this geographical region. These findings are consistent with the recent Turkish Hypertension Prevalence study (PatenT) reporting a control rate of 8.1%.

Cut-off values for waist circumference in Turkish population: Is there a threshold to predict insulin resistance?

OBJECTIVES: To identify the cut-off values for waist circumference (WC) that may best predict cardiometabolic risk associated with insulin resistance in adult Turkish men and women. STUDY DESIGN: A total of 1,039 non-diabetic subjects (592 females, 447 males; mean age 40.2+/-12.8 years) aged = or >18 years were enrolled. Insulin resistance was assessed with homeostasis model assessment of insulin resistance (HOMA-IR). The subjects were classified into quantiles based on the WC values and quantiles were compared with respect to the HOMA-IR levels. Receiver operating characteristic (ROC) analysis was used to identify the WC cut-off value that would best predict insulin resistance. RESULTS: HOMA-IR values increased in parallel with increasing WC quantiles for both genders (p=0.001). The cut-off values for WC that showed the highest sensitivity and specificity to predict insulin resistance were 93 cm for men (91.6% and 51%, respectively) and 83 cm for women (91.1% and 34.8%, respectively). CONCLUSION: Our results demonstrate that the cut-off values for WC that would best predict cardiometabolic risk associated with insulin resistance are 93 cm for men and 83 cm for women in Turkish adults. However, our findings also raise the question as to whether it is indeed necessary to define a WC cut-off value for the prediction of insulin resistance, because, regardless of the cut-off WC value taken into account, insulin resistance will be overlooked in a significant number of individuals with a WC below this cut-off value.

Effects of different statin treatments on small dense low-density lipoprotein in patients with metabolic syndrome.

AIM: To compare the effects of different low-density lipoprotein (LDL) cholesterol-lowering statin treatments on small dense LDL (sd-LDL) in hypercholesterolemic patients with metabolic syndrome (MetS). METHODS: Forty hypercholesterolemic MetS patients ?30 years of age were randomized to rosuvas-tatin (n=17) or other statins (n=23) groups. In the other statins group, those taking atorvastatin (n=12) were also evaluated separately. Statin doses were 10 mg/day rosuvastatin, 20 mg/day atorvas-tatin, 40 mg/day simvastatin, and 40 mg/day pravastatin. Treatment duration was planned to be 8 weeks. Sd-LDL levels were assessed at baseline and at the completion of treatment. RESULTS: After treatment, sd-LDL levels were significantly reduced in all 3 groups (from 29.6+/-24.8 mg/dL to 8.9+/-8.5 mg/dL in the rosuvastatin group, p=0.001; from 26.2+/-15 mg/dL to 14.8+/-9.6 mg/dL in the atorvastatin group, p=0.02; and from 29.1+/-16.5 mg/dL to 14.7+/-11.2 mg/dL in the other statins group, p=0.0001). There was no significant difference in the mean percent changes among groups. CONCLUSION: Significant reduction in sd-LDL levels was observed after 8 weeks of statin treatment in hypercholesterolemic patients with MetS. This effect was similar for all statins and can be considered a class effect.

Frequency of abdominal obesity and metabolic syndrome in healthcare workers and their awareness levels about these entities.

OBJECTIVES: We investigated the frequency of metabolic syndrome (MetS) and abdominal obesity and evaluated the level of awareness about these two conditions in healthcare workers. STUDY DESIGN: A total of 723 healthcare workers (372 physicians, 247 nurses, 104 other healthcare staff; mean age 32.8+/-8.2 years) from four centers were included. Demographic, anthropometric, and biochemical data were recorded, lifestyle features were inquired, and the levels of awareness about abdominal obesity and MetS were surveyed. The criteria recommended by the Adult Treatment Panel (ATP) III were used for the diagnosis of abdominal obesity and MetS. The presence of MetS was evaluated in 178 subjects. Univariate and multivariate analyses were performed to evaluate the association between lifestyle features and abdominal obesity. RESULTS: The frequency of abdominal obesity was 13.8% and it was significantly higher in males than in females (19.1% vs 10.6%; p=0.002). Metabolic syndrome was diagnosed in 14 participants (7.9%), and there was no significant difference between men and women in this respect (p>0.05). The cut-off values for abdominal obesity and at least three criteria of MetS were correctly listed by 47 participants (6.5%) and 240 participants (33.2%), respectively, with physicians showing significantly higher awareness levels (p=0.001). In multivariate analysis, age =or>40 years and male gender were significantly associated with abdominal obesity. CONCLUSION: Our results demonstrate that only a minority of healthcare workers are cognizant of MetS as a clinical syndrome and the definition of abdominal obesity.

Short term fluvastatin treatment lowers serum asymmetric dimethylarginine levels in patients with metabolic syndrome.

Elevated concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, are associated with endothelial dysfunction. Metabolic syndrome (MetS) is also a condition associated with impaired endothelial function. To test the hypothesis that lipid lowering treatment with a statin lowers ADMA levels, we investigated the effect of fluvastatin treatment on serum ADMA levels in patients with MetS. A total of 85 hypercholesterolemic MetS patients (53 females, 32 males; mean age, 55.8+/-9.1 years) were included in this prospective, randomized, controlled study. Patients were randomly assigned to either the treatment (n=42) or control group (n=43). Recommendations for lifestyle modification were provided to both groups. In addition, the patients in the treatment group received fluvastatin, extended release tablets, 80 mg/day, orally for 6 weeks. Serum levels of ADMA and lipids were assessed at baseline and at the completion of treatment. High performance liquid chromatography was used to measure serum ADMA concentrations. In the fluvastatin group, there was a significant reduction in serum ADMA levels compared to baseline (from 1.57+/-1.07 micromol/L to 1.17+/-1.41 micromol/L, P<0.05), whereas in the control group no significant change was observed (from 1.06+/-0.46 micromol/L to 1.24+/-1.38 micromol/L, P>0.05). There was a statistically significant difference between the groups in terms of mean percent change from baseline (P=0.047). Fluvastatin treatment for hypercholesterolemia in patients with MetS is associated with a decrease in serum ADMA levels at 6 weeks. This finding is consistent with known beneficial effects of statin treatment on endothelial function in hypercholesterolemic patients.

Dietary breads: myth or reality?

AIMS: To assess the differences in acute effects of whole wheat bread, wheat bran bread and rye bread--perceived as dietary (Low caloric!) breads--on glucose and insulin levels in patients with type 2 diabetes, as compared to white wheat bread. METHODS: One hundred twenty one type 2 diabetic patients were randomized into three groups as whole wheat, wheat bran and rye bread groups. Each group ate 100 g of bread with water with in 10 min. Blood glucose measurements were made at every 30 min in 2 h. Insulin was measured at fasting and at the second hour in the patients who do not use insulin. The same processes were repeated on the following day, with white wheat bread for each group. RESULTS: No significant difference was found in either glycemic or insulinemic effects between four types of breads when compared to each other (p=0.093 for glycemic effect and p=0.297 for insulinemic effect). CONCLUSION: Three different bread types consumed as an alternative to white bread in Turkey, increase blood glucose levels of diabetic patients similar to white bread.