Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier's disease with an underlying lipoma: A case report.

BACKGROUND: Ménétrier's disease is a rare condition characterized by enlarged gastric folds, usually located in the whole body and fundus of the stomach. This report presents an unusual case of localized Ménétrier's disease elevated by a submucosal lipoma and thus looking like a polypoid mass and causing an episode of upper gastrointestinal bleeding. The mass was successfully removed with endoscopic submucosal dissection. CASE SUMMARY: Esophagogastroduodenoscopy was performed on a 76-year-old male patient after an episode of upper gastrointestinal bleeding, manifesting as fatigue and melena. A large polypoid mass (4 cm × 1 cm) with enlarged mucosal folds was found in the body of the stomach, between the lesser curvature and posterior wall. A small ulcer at the distal end of the mass was identified as the source of the bleeding. Biopsy was negative for neoplasia. Computed tomography showed a submucosal lesion beneath the affected mucosa, most likely a lipoma. The mass was removed en bloc with tunneling endoscopic submucosal dissection. Final pathology determined that the mass included Ménétrier's disease and a submucosal lipoma. The patient was scheduled for follow-up esophagogastroduodenoscopy. CONCLUSION: Localized Ménétrier's disease can coexist with a submucosal lipoma creating a polypoid mass with risk of bleeding.

Moderate Caloric Restriction Partially Improved Oxidative Stress Markers in Obese Humans.

Oxidative stress and inflammation are implicated in obesity. Therefore, we investigated whether moderate and short-term calorie restriction (CR) reflects a real-life situation, mediates weight loss, and improves oxidative stress markers. We analyzed oxidative stress markers in patients with obesity undergoing moderate CR. Serum oxidative stress markers (myeloperoxidase (MPO), superoxide dismutase (SOD), catalase, total antioxidant status (TAS), and reactive oxygen species (ROS) (generation by endothelial cells in vitro)) were measured in 53 subjects (mean BMI 37.8 ± 5.9 kg/m2) who underwent 8 weeks of CR, which included a reduction of 300-500 kcal/day. MPO was the most CR-sensitive parameter. The mean level of serum MPO in patients with obesity was 20% higher than that in post CR intervention (p < 0.001). SOD increased by 12% after CR (p < 0.05), which was largely due to the improvement in glucose tolerance and the reduction in insulin resistance after CR. Other tested parameters were not modified during the treatment. CR resulted in an expected decrease in body weight (by 5.9 ± 4.6 kg, p < 0.0001) and other anthropometric parameters. Additionally, it was accompanied by a significant change in hsCRP, hsTNF alpha, hsIL-6, leptin (all p < 0.0001), and HOMA-IR (p < 0.05). Cardiovascular and metabolic parameters were also partially improved. Short-term, moderate CR partially improves antioxidant capacity but is enough to substantially change anthropometric parameters in obese patients. Our observations indicate that mimicking real-life situations and low-cost dietary intervention can be successfully implemented in obesity treatment with a simultaneous moderate effect on antioxidant status.

[Medical error in theory and practice - a review of the most important issues]. / Blad medyczny w teorii i praktyce ­ przeglad najwazniejszych zagadnien.

In recent years, in Poland, despite the lack of an adverse medical events monitoring system, a sharp increase in the number of complaints to various medical and legal institutions, as well as court cases with a suspicion of a medical error, was found, based on the available reports and statistics, which poses a serious medical and legal. The aim of this study was to review the theoretical and practical issues of medical errors in the medico-legal context on the basis of the current legislation in Poland. This paper presents the conceptual scope and the evolution of terminology, starting from "error in the medical art/craft" up to the currently defined and used concept of "medical error." The problem of medical errors in medico-legal categories, according to Polish legal regulations and ethical standards in medicine, was also considered. Different classifications, as well as the causes and consequence of various medical errors, were analyzed. Based on current literature, Polish judicial decisions were reviewed, and some examples of legal rulings with respect to different categories of medical errors were presented. Given the ambiguity, both in conceptual and categorizing terms, with regard to adverse medical events: errors, negligence, malpractice and omission, it would be justified to adopt an unambiguous definition and classification. Such an arrangement would expand the possibilities of research in the field of etiology of medical errors, and more importantly, prepare such procedures that would maximally protect the patient, and allow the maximum reduction of the number of medical errors and any other adverse events. In addition, specifying the medical, legal and economic standards in medical units, and determining the scope of personal and institutional responsibility for undesirable medical events, would, in turn, improve the processing of claims made by patients or their families, as well as the activities of medical and legal institutions, including doctors appointed as court experts. Med Pr. 2020;71(5):613-30.

Characteristics of salivary inflammation in obesity.

INTRODUCTION: The discovery of the secretory function of adipose tissue has led to a new direction in research on obesity­ related health problems. Adipokines are present not only in blood but also in saliva. Numerous studies have indicated that obesity affects salivary concentrations of adipokines. OBJECTIVES: The aim of this study was to evaluate the levels of selected inflammatory markers in saliva and to determine their discriminatory value in obese individuals. PATIENTS AND METHODS: The study included 125 patients (82 women and 43 men), aged from 20 to 65 years. There were 59 patients with obesity (body mass index [BMI] >30 kg/m2) and 66 controls with normal body weight (BMI <25 kg/m2). Mixed saliva samples were collected from all participants to determine the concentrations of the following inflammatory markers: tumor necrosis factor­ α receptors 1 and 2, pentraxin 3, interleukin 15, monocyte chemoattractant protein 1, soluble intercellular adhesion molecule 1, and soluble CD40 ligand (sCD40L). RESULTS: Compared with controls, individuals with obesity had significantly higher levels of all inflammatory markers except sCD40L levels, which were lower. The salivary marker sCD40L seems to have the best discriminatory value in obesity regardless of sex, with the optimal cutoff point of 3.28 pg/ml and the area under the curve of 0.8. CONCLUSIONS: Obesity may be associated with altered levels of selected inflammatory markers in saliva. The discriminatory values determined in this study may facilitate the diagnosis of metabolic diseases.

Assessment of nutritionnal status and nutrition in patients with arterial hypertension.

INTRODUCTION: The factors predisposing to the occurrence of cardiovascular event are mainly age, visceral obesity and metabolic syndrome. To our knowledge, there are no studies assessing both the nutritional status and diet of hypertensive patients in Poland. AIM: Our aim is the assessment of the diet and nutritional status of patients with hypertension. MATERIAL AND METHODS: This study included 50 patients (K: 32, M: 18) with hypertension admitted to the Department of Internal Medicine at the Heliodor Swiecicki Clinical Hospital in Poznan. Anthropometric measurements (waist and hip circumference), and body composition analysis were used to assess nutritional status. Additionally, we carried out the nutritional interview. RESULTS: We observed that among hypertensive patients, overweight occurred in 18% and obesity (definition based on BMI) in 48% of all patients. We found that visceral obesity (definition based on WHR) concerns 76% of patients. Moreover, we diagnosed a metabolic syndrome in 56% of patients. None of the patients treated the DASH diet, especially recommended for the treatment of hypertension. What's more, as many as 50% of hypertensive patients used salt for meals twice a day. CONCLUSIONS: In patients with hypertension the frequent occurrence of obesity and metabolic syndrome may to a large extent result from the dietary support deviating from the rational diet. There is a need to educate patients with arterial hypertension in the field of non-pharmacological treatment methods, especially diet therapy.

The Clinical Importance of 21-Day Combined Parenteral and Enteral Nutrition in Active Inflammatory Bowel Disease Patients.

The aim of the study was to show the clinical magnitude of short-term feeding: enteral nutrition (EN) combined with parenteral nutrition (PN) in active Crohn's disease and ulcerative colitis patients. Among 122 eligible inflammatory bowel disease (IBD) patients, 65 met the inclusion criteria. Combined EN and PN was administered for 21 days, wherein over the first 3-5 days of treatment, trophic enteral nutrition (300 kcal/day) was used with an energy increase of up to 1500 kcal. An EN was administered using a nasogastric tube or, in case of intolerance, using a naso-jejunal tube. For PN, the "All in One" system was used according to individually prepared admixtures (ESPEN Guidelines). In addition to routine blood measurement (i.e., ALAT, ASPAT, GGTP, creatinine, lipid profile), the following parameters were assessed: adiponectin, leptin, (hs)TNF-α, hsIL-6 and hsIL-10, TSH, NT-proBNP, serum vitamin B12 concentration, and tHcy. The results showed a considerable improvement in all clinically significant parameters (p < 0.05), showing the benefits and importance of short-term well-balanced EN combined with PN for nutritional and clinical status in IBD patients with active disease. The daily work at hospitals with active IBD patients demonstrates the potential of continued administration of home-based nutrition by patients.

Salivary fingerprint of simple obesity.

BACKGROUND: The nature of a link between poor oral health and obesity is not fully understood. It is also unclear if saliva contributes to it and whether the properties of saliva change as a result of an increase in body mass or rather as a consequence of obesity-associated comorbidities. This pilot study was undertaken in an attempt to determine if salivary biomarkers can identify obesity per se. METHODS: Whole mixed saliva was analysed for 16 soluble parameters covering 4 categories (inflammation, oxidative stress, endothelial dysfunction, adipokines). In the discovery group, 19 obese and 25 non-obese women matched for age, with similar hygiene habits, with no comorbidities and not taking any medication known to affect saliva secretion were analysed. In the validation group, a cohort of no-preselected 81 individuals (34 obese) were analysed. RESULTS: Individuals with obesity had significantly higher salivary concentrations of several cytokines and adipokines, of which TNF-R1, serpin A12 and PAI-1 were identified as parameters discriminating between obese and non-obese subjects with the highest sensitivity and specificity. CONCLUSIONS: Obesity per se leads to distinct changes in the concentration of several parameters in saliva. These findings may have diagnostic implications for distinguishing the effects of obesity and obesity-linked comorbidities on oral health.

Iron status in obese women.

INTRODUCTION AND OBJECTIVE: A decreased concentration of iron, and consecutively haemoglobin, ferritin and decreased level of saturated transferrin, were observed in obese individuals more often than in healthy subjects. The purpose of this study was to determine whether iron, ferritin, transferrin saturation are significantly diminished in obese female patients compared to non-obese counterparts, and whether excess adiposity and inflammation were associated with depleted iron. MATERIAL AND METHODS: Female patients (n=48) diagnosed with obesity (BMI > 30 kg/m2), aged 18-40 were accepted for the study. A control group (n=30) encompassed normal weight women, aged 18-30. All obese women obtained an individually adjusted dietary plan with an energy content of 1,500 kcal. Blood glucose, insulin, lipids, ferritin, TIBC and iron concentrations were assayed in serum twice, initially and after 8 weeks of dieting. RESULTS: The obese women at the initial evaluation, in comparison to non-obese control women, were characterized by a significantly lower mean red blood cell volume (MCV; 84.2±12.4 vs. 91.3±9.3 fL; p<0.0001), serum iron level (92.6±42.4 vs. 119.8±44.0 µg/dL; p<0.01), and transferrin saturation (TSAT; 25.9±12.7 vs. 38.8±15.7%; p<0.01), but by higher plasma level of the C-reactive protein (CRP; 7.0±6.7 vs. 1.2±1.3 mg/L; p<0.01). The obese women after 8 weeks of diet decreased their mean total body weight from 104.1±21.3 to 99.2±20.7 kg (p<0.0001). CRP level decreased slightly but significantly from 6.9±7.1 to 6.2±7.5 (p<0.05). CONCLUSIONS: Obese women exhibit an increased level of CRP which may affect iron homeostasis. Weight loss leads to decrease in the CRP level, but it does not change haematologic parameters in the period of 8 weeks.

The effect of orlistat versus metformin on body composition and insulin resistance in obese premenopausal women: 3-month randomized prospective open-label study.

INTRODUCTION: Our aim was to evaluate the effects of metformin and orlistat on body composition and glucose-insulin homeostasis in obese premenopausal women. MATERIAL AND METHODS: Seventy-three obese premenopausal Caucasian women aged 32.4 ±8.3 years were treated with either metformin (1000 mg/day; n = 37) or orlistat (360 mg/day; n = 36). Anthropometric parameters were measured using dual-energy X-ray absorptiometry. Glucose tolerance, using the oral glucose tolerance test; insulin resistance, using the homeostasis model assessment (HOMA-IR); and insulin sensitivity, using the Matsuda insulin sensitivity index (ISI Matsuda), were assessed at the commencement of the study and after 3 months. RESULTS: Those treated with orlistat showed greater weight loss (-9.4 ±2.3 vs. -4.9 ±1.3 kg, p < 0.05) and decrease of fat mass (-5.4 ±3.0 vs. -3.5 ±0.7 kg, p < 0.05) than those treated with metformin. The percentage of android and gynoid fat deposits was reduced in both groups; however, a greater decrease in android fat was observed in those treated with metformin. Improvement in ISI Matsuda and post-load insulin were similar in both groups. High initial post-load insulin and low ISI Matsuda corresponded with reductions in total fat, trunk fat, and waist circumference in both groups, and a decrease in android fat in those treated with metformin. CONCLUSIONS: Orlistat treatment resulted in greater weight loss and improvement in body composition; metformin treatment resulted in a reduction of android fat. Both drugs produced a comparable improvement in insulin/glucose homeostasis. Overall, insulin-resistant women showed improvement with treatment, irrespective of which drug was used.

Association of endothelial proliferation with the magnitude of weight loss during calorie restriction.

OBJECTIVES: Substantial weight loss through intense dietary regimens is thought to ameliorate endothelial dysfunction in obesity. It is less clear whether similar improvements can be achieved with modest dietary interventions. This study aimed to identify the parameters of endothelial cell status in obesity that are affected by mild calorie restriction. METHODS: Human umbilical vein endothelial cells (EA.hy926 line) in culture were exposed pairwise to serum from 57 individuals with simple obesity (BMI > 30 kg/m(2)) collected before and after 8-week dietary intervention with energy deficit of 300-500 kcal/day. RESULTS: Analysis of endothelial transcriptome suggested that the intervention could impact on endothelial cell growth. Cell proliferation was measured with the MTT test and verified by [(3)H]-thymidine incorporation. The participants were categorized according to a change in proliferation over time. Significant decrease in endothelial cell proliferation correlated with the extent of weight loss in men, but not in women. This effect corresponded with changes in serum levels of leptin and adiponectin, but was not related to serum concentrations of several known angiogenic mediators (VEGF, MCP-1, TSP-1, MMP-9, angiopoietin-2). CONCLUSION: Direction and magnitude of changes in serum-induced endothelial cell proliferation identifies patients with the greatest weight loss in response to modest calorie restriction.

Applicability of endoscopic indices in the determination of disease activity in patients with ulcerative colitis.

OBJECTIVE: The combination of clinical remission and mucosal healing represents a major goal of different treatment strategies for ulcerative colitis (UC). This study aimed to assess which of the endoscopic indices used to evaluate mucosal changes in UC are correlated with clinical indices currently used to determine disease activity, as well as which of the endoscopic indices are correlated with the Geboes Index used for histological evaluation. It also aimed to find correlations between the currently used clinical activity indices and the histological Geboes Index. METHODS: A group of 49 patients with a confirmed diagnosis of UC and a group of 52 individuals without a diagnosis of gastrointestinal disease, who constituted the control group, were investigated. All patients were evaluated by colonoscopy, and the severity of mucosal changes was scored in terms of nine different endoscopic indices commonly used in both pharmacological trials and clinical practice. Evaluation was also carried out using clinical and histological indices. Endoscopic indices used for UC were then correlated with different clinical and histological indices to find the strongest correlations. RESULTS AND CONCLUSION: A high correlation was demonstrated between three of the 11 evaluated clinical indices - Improvement Based on Individual Symptom Scores, Ulcerative Colitis Disease Activity Index, and Schroeder Index - and all nine endoscopic indices - Ulcerative Colitis Endoscopic Index of Severity, Baron Score, Schroeder Index, Feagan Index, Powell-Tuck Index, Rachmilewitz Index, Sutherland Index, Lofberg Index, and Lemman Index. Improvement Based on Individual Symptom Scores was the index with the highest correlation with all the endoscopic indices used for UC. The above indices are recommended for clinical evaluation of UC activity. The Ulcerative Colitis Endoscopic Index of Severity was moderately correlated with a histological index, and it is therefore recommended for routine endoscopic mucosal evaluation in patients with UC.

The effects of a low-calorie diet or an isocaloric diet combined with metformin on sex hormones In obese women of child-bearing age.

BACKGROUND: The influence of weight loss treatment on sex hormones profile has been studied mainly in women with polycystic ovary syndrome (PCOS), but in obese premenopausal women without PCOS it still remains unclear. The aim of the study was to evaluate the effect of two approaches to obesity treatment on the serum level of sex hormones in obese women of child-bearing age without PCOS. METHODS: 77 obese Caucasian women (aged 31.2 ±8.3 years) were randomized into two groups: 39 women received a low-calorie diet (LC) and 38 received an isocaloric diet plus metformin (IM), for 12 weeks. Anthropometric parameters, body composition and serum concentrations of estradiol (E2), testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and dehydroepiandrosterone (DHEA-S) sulfate were evaluated at baseline and after the study. RESULTS: Reductions in body weight, body mass index (BMI), waist and body fat content with an increase  in lean body percent were significant and comparable between the LC and IM group after the trial. The concentrations of serum FSH, LH, E2, DHEA and T did not change in either group after treatment. A tendency towards an increase in the E2 concentration in both groups and a decrease in the T level in the LC group  was observed. The correlations between a change in BMI, fat content, waist-hip ratio and a change in T were documented in the LC group. CONCLUSIONS: A 12-week low-calorie diet and an isocaloric diet combined with metformin produced comparable and significant weight loss with improvements in body composition. Both interventions did not significantly affect FSH, LH and DHEA sulfate serum concentrations, only a trend towards an E2 increase and a T decrease was observed, stronger in LC group. The significant correlations shown between the changes in anthropometric and body composition parameters and T serum levels in women treated with a low-calorie diet alone show the beneficial effect of a lifestyle intervention on the sex hormone in obese premenopausal women.

[Hygienic habits and health behaviors in patients with obesity].

Introduction: Smoking is the most common addiction in the world. Coexistence of smoking and obesity lead to a significant increase in the risk of cardiovascular diseases. It is also known that both the tobacco and excessive weight have a negative impact on oral health. Aim: Assessment of the frequency of smoking, hygienic habits and healthy behaviors in people with obesity. Material and Methods: The study included 125 people, of both sexes, aged from 20 to 65 years. The study group consisted of patients Clinic of Internal Medicine, Metabolic and Nutrition, Poznan University of Medical Sciences with a BMI> 25 kg/m2, control group - patients Clinic of Conservative Dentistry and Periodontology, Poznan University of Medical Sciences of normal weight (BMI <25 kg/m2). All participants were asked to complete a short survey on smoking, frequency of dental checkups and hygiene habits associated with the oral cavity. Results: In both groups of patients, obese and normal weight, we found similar percentages of smokers: 25 and 24.24%. Both groups showed a similar time of brushing, however, we found statistically significant differences in the frequency of tooth brushing. Conclusion: Despite the similar results obtained during the survey in both groups of patients, it seems necessary to take patients with obesity particularly dental care, enhancement of preventive measures as well as incitement to refrain from smoking.

Usefulness of selected laboratory markers in ulcerative colitis.

INTRODUCTION: This study aimed to compare the accuracy of selected laboratory markers in assessing disease activity in patients with ulcerative colitis (UC). The analysis included serum IL-2, IL-4, IL-6, IL-10, IL-17, TNF-, IFN-, hsCRP, peripheral regulatory T cells, as well as fecal calprotectin and lactoferrin. PATIENTS AND METHODS: A group of 45 adults with UC was enrolled in the study. Disease activity was assessed using the Mayo endoscopic index, while for clinical activity scoring, the Clinical Activity Index (CAI) was used. Concentrations of markers investigated were estimated by means of flow cytometry and enzyme-linked immunosorbent assays: the results were correlated with both indices. RESULTS: The study demonstrated that both fecal markers, i.e. calprotectin (r = 0.880, P<0.001) and lactoferrin (r = 0.799, P<0.001) correlated closely with the Mayo endoscopic score, and might be used to evaluate the severity of UC in the clinical setting. The correlation of these markers with CAI was also significant, with r = 0.831 for calprotectin (P<0.001) and r = 0.672 for lactoferrin (P<0.05). As for the other markers investigated, only IL-6 (r = 0.598, P<0.001), IL-17A (r = 0.587, P<0.005), and TNF- (r = 0.701, P<0.001) correlated closely with the Mayo endoscopic index. The correlation of the markers with CAI was also significant, though weaker, with r = 0.525 for IL-6 (P<0.001), r = 0.587 for IL-17A (P<0.05), and r = 0.624 for TNF- (P<0.001). DISCUSSION: Despite the fact, that UC is generally considered to be an IL-13-driven, Th2-like type of disease, markers of inflammation such as serum interleukin (IL)-6, IL-17, TNF-, fecal calprotectin and lactoferrin might be useful in assessing disease activity.

Selected biologic markers of inflammation and activity of Crohn's disease.

The study aimed to compare the accuracy of selected biologic markers in assessing the disease activity in patients with Crohn's disease (CD). The analysis included serum IL-2, IL-6, IL-17, TNF-α, IFN-γ, hsCRP, peripheral CD4 + CD25 + FOXP3 + regulatory T cells, as well as fecal calprotectin and lactoferrin. A group of 55 adults with CD was enrolled to the study. Disease activity was assessed using Crohn's Disease Endoscopic Index of Severity (CDEIS), which currently represents the gold standard for the evaluation of endoscopic activity. For clinical activity scoring, the Crohn's Disease Activity Index (CDAI) was used. Concentrations of investigated markers were estimated by means of flow cytometry and enzyme-linked immunosorbent assays, and the results were correlated with both indices. The study demonstrated that both fecal markers, i.e. calprotectin (r = 0.827, p < 0.001) and lactoferrin (r = 0.704, p < 0.001), correlate closely with CDEIS score, and might be used to evaluate the severity of CD in clinical setting. The correlation of those markers with CDAI was also significant, with r = 0.742 for calprotectin (p < 0.001) and r = 0.675 for lactoferrin (p < 0.05). As for the other investigated markers, only hsCRP (r = 0.672, p < 0.001) and IL-17 (r = 0.296, p < 0.005) correlated closely with CDEIS. The correlation of the markers with CDAI was also significant, though weaker, with r = 0.518 for hsCRP (p < 0.001) and r = 0.296 for IL-17 (p < 0.05). The study showed that IL-17, despite its vague role in the pathogenesis of CD, might be a useful marker, comparable with hsCRP, in assessing the activity of the disease.

Assessment of nutritional knowledge of patients with pancreatitis.

INTRODUCTION: Proper nourishment is one of the basic elements in the treatment of patients with both acute and chronic pancreatitis. Following acute pancreatitis, the essential element of nutritional treatment is dietary education. The dietary approach is used not only for treatment, but also for prevention of reoccurrence of the condition. AIM: To evaluate nutritional knowledge of patients with acute and chronic pancreatitis. MATERIAL AND METHODS: The selected group consisted of 36 patients, 19 females and 17 males, suffering from acute or chronic pancreatitis. Participation in our survey was anonymous and voluntary. The study population was divided into two groups: 12 patients with acute pancreatitis (5 males and 7 females) and 24 patients with chronic pancreatitis (12 males and 12 females). The median age of patients was 42.4 ±14 years (range: 20-76 years). The duration of illness among the study population was varied. The biggest group of 16 (44.4%) patients suffered from pancreatitis for more than 5 years, 8 (22.2%) patients had pancreatitis diagnosed 1-2 years previously, only 3 (8.3%) subjects suffered from pancreatitis for shorter than half a year. To analyse patients' nutritional knowledge an authorial questionnaire was used that contained 17 closed questions and open-type questions were used three times. RESULTS: Most (97%) subjects with acute and chronic pancreatitis adhered to the diet to various degrees, but almost 50% of people up to 35 years of age declared that they didn't respect the diet, or that they followed only a few recommendations. Despite each interviewer admitted to follow dietary recommendations for pancreatitis, 11.1% of patients could not indicate any of them. Most patients knew that their diet should contain a low amount of fat (61% of patients). Awareness of alcohol abstinence was confirmed in 44.4% of subjects. One third (33.3%) of patients knew that fried food should be avoided. Only a few patients were aware that smoking, spicy food, and strong coffee should be excluded from their diet. About 80% of the surveyed patients evaluated their level of nutritional knowledge as good or very good. Only 20% of the study population admitted their dietary knowledge was unsatisfactory, and most of these were woman (86%). CONCLUSIONS: The results of the present study demonstrate that dietary knowledge among patients suffering from acute and chronic pancreatitis is insufficient. Although patients have theoretical knowledge about nutritional management, they have problems implementing the diet on a daily basis. It is necessary to pay more attention to nutritional education for patients suffering from pancreatitis.

Obesity - should we revise indications for treatment with metformin?

INTRODUCTION: Treatment of obesity with life style modifications often fails; therefore pharmacological treatment has become a very popular approach. Metformin is one of the examined possibilities. The aim of this study was to verify indications for metformin use in obese women based on metabolic and anthropometric parameters assessed by dual-X-ray absorptiometry (DXA), to establish the degree of insulin resistance and its correlations. MATERIAL AND METHODS: Anthropometry, fat measurement by bioimpedance and metabolic profile, including lipids, and oral glucose tolerance test (OGTT) with insulin (0 and 120 min) were performed in 50 female patients diagnosed with simple obesity, aged 18-40 years. Homeostatic model assessment HOMA-R was calculated for insulin resistance, and area under the curve (AUC) for insulin response. Total, android and gynoid fat distribution, and their ratio (A/G), were measured by DXA. RESULTS: From 50 women who entered the study, 33 were classified as insulin resistant (IR subgroup) and 17 as non-insulin resistant (non-IR subgroup), according to their HOMA-R indices. IR women presented higher waist circumference and DXA A/G ratio. The IR subgroup demonstrated elevated fasting triglycerides and glucose (but in the normal range) and a higher insulin response in OGTT (4.1-fold vs 2.5-fold). From different insulin measurements HOMA index turned out to have the strongest correlations with the metabolic parameters triglycerides and glucose. We found significant positive correlations between android fat and insulin: waist circumference and HOMA-R, WHR and HOMA-R, android fat and HOMA-R, A/G ratio and insulin after OGTT, and A/G ratio and HOMA-R. We found a strong correlation between WHR and A/R ratio. CONCLUSIONS: 67% of premenopausal obese women were insulin resistant. Measures of DXA visceral fat determined by android fat percentage and android/gynoid ratio were the strongest determinants of insulin resistance. Waist-to-hip ratio might be a simple method for determining the indications for metformin treatment.