Fetuin A as a new marker of inflammation in Hashimoto thyroiditis.

AIM: Fetuin-A levels are reported to be low as a negative acute phase reactant in systemical inflammatory situations. Hashimoto thyroiditis is characterized with inflammation. In this study, we hypothesised that the serum fetuin A levels could be found to be low due to inflammation in patients with Hashimoto thyroiditis. For this purpose, serum fetuin A levels in patients with Hashimoto thyroiditis were compared with those in healthy subjects. METHODS: A total of 85 participants (11 male, 74 female, mean age: 38.60±10.14 years) were included. The patient group consisted of 44 Hashimoto thyroiditis patients with subclinical hypothyroidism (7 male, 37 female) and the control group consisted of 41 healthy subjects (4 male, 37 female). Groups were compared according to their demographic, anthropometric and biochemical data and serum fetuin-A levels. Correlation analysis was used for determining the relation between fetuin A levels and clinical parameters. RESULTS: Fetuin-A levels of the patient group were found lower than those of the control group (0.58±0.50 g/L versus 1.53±1.60 g/L, P=0.001). Fetuin-A levels were not correlated with clinical parameters such as TSH, C-reactive protein, body mass index, waist circumference, blood pressure, glucose, and lipids. CONCLUSION: These findings supported the hypothesis that serum fetuin A levels could be found to be low as a negative acute phase reactant in patients with Hashimoto thyroiditis. Fetuin A can be considered as an indicator of inflammation in Hashimoto thyroiditis.

Frequency of metabolic syndrome and 25-hydroxyvitamin D3 levels in patients with non-alcoholic fatty liver disease.

AIM: It is known that insulin resistance has an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and that serum 25-hidroksivitamin D3 [25-(OH)D] levels are found low in the presence of insulin resistance. Metabolic syndrome (MetS) is characterized by insulin resistance. The purpose of the present study was to determine the levels of 25-(OH)D and the frequency of MetS in patients with NAFLD, and to evaluate the association of 25-(OH)D with the histology of NAFLD and metabolic parameters. METHOD: Sixty-three patients with NAFLD confirmed by liver biopsy (29 females and 34 males, mean age 42.70±9.82 years) and 46 healthy controls (16 females and 30 males, mean age 37.54±8.56 years) were included in the study. International Diabetes Federation criteria were used for MetS diagnosis. Insulin resistance was determined according to the Homeostasis Model of Assessment (HOMA-IR) method. The groups were compared for 25-(OH)D levels and MetS frequencies. Correlation analysis was used to evaluate relationships between 25-(OH)D and metabolic parameters and/or NAFLD histology. RESULTS: 25-(OH)D levels were lower in the NAFLD group compared to the control group (36.06±13.07 ng/mL vs. 51.19±23.45 ng/mL, respectively, P<0.01), while MetS frequency was higher (66.7% vs. 15.2%, P<0.01). In the NAFLD group, 25-(OH)D levels were negatively correlated with non-alcoholic steatohepatitis scores and HOMA-IR (r=-0.317, P=0.011 and r=-0.437, P=0.001, respectively). CONCLUSION: The present study demonstrated higher frequency of MetS and lower levels of 25-(OH)D in patients with NAFDL, and a negative association of 25-(OH)D levels with non-alcoholic steatohepatitis scores and insulin resistance.

Is prevalence of metabolic syndrome high in patients with asthma?

AIM: It has been reported that people with asthma may have an increased risk of cardiovascular disease and metabolic disorders due to direct involvement of common inflammatory mediators. Metabolic syndrome (MetS) is also characterized by inflammation, In this study, we hypothesised that the prevalence of MetS would increase in patients with asthma. Based on this, we evaluated the prevalence of MetS in patients with asthma and the relationship between asthma and cardiometabolic risk factors. MATERIALS AND METHODS: The study included a total of 188 non-diabetic patients. The asthma group (70 female, 20 male, mean age: 43.83 +/- 10.98) included the patients who were diagnosed with asthma by a pulmonologist, while the control group (81 female, 17 male, mean age: 42.01 +/- 9.21) included non-asthmatic patients who presented for routine health control. The primary endpoint of the study was to compare the prevalence of MetS between the groups, while the secondary endpoint was to evaluate the relationship between asthma and cardiometabolic risk factors such as body mass index, waist circumference, blood pressure, lipid parameters, C-reactive protein, fasting plasma glucose, uric acid and homeostasis model assessment of insulin resistance. The International Diabetes Federation criteria were used for the diagnosis of MetS. RESULTS: Although the prevalence of MetS was slightly higher in the asthma group than in the control group (36.7% vs. 33.7%, respectively), the difference was not statistically significant (p > 0.05). In multivariate logistic regression analysis, C-reactive protein (OR 2.204; 95% CI; 1, 129-4, 303) was associated with asthma. CONCLUSION: Although there are numerous rational theories proposing that asthma can be associated with MetS, the results of the present study, which was conducted with a limited number of patients, find no arguments for higher prevalence of MetS in asthma patients compared to the overall population.

The effect of infliximab treatment on insulin resistance in patients with rheumatoid arthritis.

AIM: It is well known that increased insulin resistance is associated with the development of cardiovascular disease in patients with rheumatoid arthritis and that tumour necrosis factor-alpha plays an important role in this process. Infliximab is a chimeric monoclonal anti-tumour necrosis factor-alpha antibody. This study investigates the effects of long term infliximab treatment on insulin resistance in patients with rheumatoid arthritis. MATERIALS AND METHODS: Seven rheumatoid arthritis patients (6 female and 1 male; mean age: 44.6 +/- 12.3, mean duration of disease: 6.8 y) for whom infliximab treatment had been planned at the rheumatology and internal medicine clinics were included. Patients were evaluated during and at the end of the study with a mean follow-up duration of 9.6 months. Fasting plasma glucose, fasting plasma insulin levels and serum lipid profile were assessed at baseline and throughout the treatment period (prior to every infusion). Homeostasis Model Assessment of Insulin Resistance model was used for the assessment of insulin sensitivity. RESULTS: Fasting insulin and Homeostasis Mode Assessment of Insulin Resistance levels decreased after treatment (from 19.4 +/- 7.7 microU/ml to 8.9 +/- 4.1 microU/ml and from 2.4 +/- 1 to 1.1 +/- 0.5, respectively; p < 0.05 for both). No significant change was observed in other parameters. CONCLUSION: An improvement in insulin sensitivity was observed in patients receiving long term infliximab treatment for rheumatoid arthritis.

In which patients will performing an oral glucose tolerance test yield the highest rate of positive results?

AIM: To determine a valid numerical score according to the present risk factors for the prediction of impaired glucose tolerance in our patients. MATERIALS AND METHODS: A total of 502 cases (340 females, 162 males; mean age: 48.3 +/- 10.3) without overt diabetes aged over 20, whose fasting plasma glucose level were below 126 mg/dl were included in this study. After fasting blood samples were drawn, a 2-h oral glucose tolerance test was performed. Bivariate and multivariate analyses were performed to obtain a numerical score for predicting impaired glucose tolerance using risk factors such as age, sex, positive family history for diabetes, body mass index, waist circumference, blood pressure, triglycerides, HDL cholesterol, and fasting plasma glucose. RESULTS: According to the 2-h plasma glucose levels, impaired glucose tolerance was detected in 96 of the patients, and diabetes was detected in 5 patients, while the remaining 401 patients had normal glycaemic values. Age (> or = 50), hypertension, high triglycerides, large waist, body mass index > or = 25 kg/m2, and a fasting plasma glucose level of 100-109 mg/dl, or 110-125 mg/dl were associated with an impaired glucose tolerance (p<0.05). In a 8-point scale formed using these 6 parameters, a score of > or = 6 could predict impaired glucose tolerance with a specificity of 99% and positive predictive value of 63%. CONCLUSION: A numerical score that could be used to predict impaired glucose tolerance in our patients has been proposed with this study.