Does bicarbonated mineral water rich in sodium change insulin sensitivity of postmenopausal women?

AIM: To study the effects of drinking 0.5 L of two sodium-rich bicarbonated mineral waters (BMW-1 and 2), with a standard meal, on postprandial insulin and glucose changes. And to determine, if the effects vary depending on insulin resistance, measured by homeostasis model assessment (HOMA). METHODS: In a 3-way randomized crossover study, 18 healthy postmenopausal women consumed two sodium-rich BMWs and a low-mineral water (LMW) with a standard fat-rich meal. Fasting and postprandial blood samples were taken at 30, 60 and 120 min. Serum glucose, insulin, cholesterol and triacylglycerols were determined. Insulin resistance was estimated by HOMA and insulin sensitivity was calculated by quantitative insulin sensitivity check index (QUICKY). RESULTS: Glucose levels did not change. HOMA and QUICKY values were highly inversely correlated (r = -1,000; p < 0.0001). Insulin concentrations showed a significant time effect (p < 0.0001) and a significant water x time interaction (p < 0.021). At 120 min insulin levels with BMW-1 were significantly lower than with LMW (p = 0.022). Postprandial insulin concentrations showed significantly different patterns of mineral water intake depending on HOMA n-tiles (p = 0.016). CONCLUSION: Results suggests an increase in insulin sensitivity after BMWs consumption. This effect is more marked in the women, who have higher HOMA values. These waters should be considered part of a healthy diet in order to prevent insulin resistance and cardiovascular disease.

Effects of pork vs veal consumption on serum lipids in healthy subjects.

AIMS: To analyse the influence of lean pork (P) and veal (V) consumption on the lipid profile of healthy subjects within the framework of a healthy diet comprising low levels of total fat (TF), saturated fatty acids (SFA) and cholesterol. DESIGN: Double-crossover, randomized and controlled trial SUBJECTS: 44 healthy individuals (22 male and 22 female), recruited voluntarily from the University Complutense of Madrid. The weight and lipid profiles of these volunteers were normal and their dietary patterns were typical for people in our area. INTERVENTIONS: The study comprised 4 phases: stabilisation phase (5 weeks), the participants followed their normal diet; second phase (6 weeks), half of the subjects, were randomised to lean pork or veal consumption, 150 g per day, for their main meal of the day; washout period (5 weeks) and final phase, which was the second phase of intervention (6 weeks). During the intervention stages, only the main meal of the day was taken in the Hospital. The rest of the subjects' diets consisted of different fortnightly menus designed in accordance with the recommendations of the Spanish Society of Arteriosclerosis (SEA). RESULTS: After both stages of intervention had been completed, there was a mean reduction of 5.5% in low-density lipoprotein cholesterol. However, after each intervention there were no significant differences between those who had consumed P, 2.62 (0.55) mmol/L and those who had consumed V, 2.71 (0.47) mmol/L. No differences were observed in any of the other parameters between those who had consumed P and those who had consumed V. CONCLUSIONS: Lean pork and veal produces similar effects on the lipid profiles of healthy subjects. Its consumption, as part of the saturated fat and cholesterol-controlled diet, could therefore be included in food guidelines, both for normal and therapeutic diets.

Red wine intake prevents nuclear factor-kappaB activation in peripheral blood mononuclear cells of healthy volunteers during postprandial lipemia.

BACKGROUND: Several epidemiological studies have demonstrated the beneficial effect of red wine intake in reducing total and cardiovascular mortality. This effect has been attributed in part to its antioxidant properties. Because the monocytes/macrophages and the nuclear transcription factor kappaB (NF-kappaB) are implicated in the pathogenesis of atherosclerotic lesions, we examined the effect of red wine intake on the activation of NF-kappaB in peripheral blood mononuclear cells. METHODS AND RESULTS: Sixteen healthy volunteers were studied 3 times each: after a moderate dose, a low dose, and no wine with a fat-enriched breakfast. Lipid profile and NF-kappaB activation (electrophoretic mobility shift assay) were examined in blood samples taken before and 3, 6, and 9 hours after wine intake. In addition, mononuclear cells were incubated with VLDL in the presence of some antioxidants (quercetin and alpha-tocopherol succinate) contained in red wine to study their effects on NF-kappaB activation. Subjects receiving a fat-enriched breakfast had increased NF-kappaB activation in peripheral blood mononuclear cells coinciding with the augmentation in total triglycerides and chylomicrons. Red wine intake prevented NF-kappaB activity even though it induced a certain increase in serum lipids, particularly VLDL, that did not increase after the fat ingestion alone. However, another form of alcohol intake (vodka) did not modify the NF-kappaB activation provided by postprandial lipemia. In cultured mononuclear cells, isolated human VLDL caused NF-kappaB activation in a time-dependent manner that did not occur in the presence of the red wine antioxidants quercetin and alpha-tocopherol. CONCLUSIONS: Our results provide a new potential mechanism to explain the beneficial effects of red wine intake in the reduction of cardiovascular mortality.

Prevalence and phenotypic distribution of dyslipidemia in type 1 diabetes mellitus: effect of glycemic control.

BACKGROUND: Data on the prevalence of dyslipidemia in type 1 diabetes mellitus are scarce and are based on total triglyceride and total cholesterol concentrations alone. OBJECTIVE: To assess the effect of glycemic optimization on the prevalence of dyslipidemia and low-density lipoprotein cholesterol (LDL-C) concentrations requiring intervention in patients with type 1 diabetes. PATIENTS: A total of 334 adults with type 1 diabetes and 803 nondiabetic control subjects. METHODS: Levels of glycosylated hemoglobin, total cholesterol, total triglyceride, high-density lipoprotein cholesterol (HDL-C), and LDL-C were assessed at baseline and after 3 to 6 months of intensive therapy with multiple insulin doses. RESULTS: Levels of LDL-C greater than 4.13 mmol/L (>160 mg/dL) and total triglyceride greater than 2.25 mmol/L (>200 mg/dL) and low HDL-C levels (<0.9 mmol/L [<35 mg/dL] in men or <1.1 mmol/L [<45 mg/dL] in women) were found in 16%, 5%, and 20% of patients and 13%, 6%, and 9% of controls, respectively (P<.001 for HDL-C). Diabetic women showed more hypercholesterolemia than nondiabetic women (15.6% vs 8.5%; P =.04). After glycemic optimization (mean +/- SD glycosylated hemoglobin decrease, 2.2 +/- 1.96 percentage points), the prevalence of LDL-C levels greater than 4.13 mmol/L (>160 mg/dL) became lower in diabetic men than in nondiabetic men (9.7% vs 17.5%; P =.04), but women showed frequencies of dyslipidemia similar to their nondiabetic counterparts. The proportion of patients with LDL-C concentrations requiring lifestyle (>2.6 mmol/L [>100 mg/dL]) or drug (>3.4 mmol/L [>130 mg/dL]) intervention decreased from 78% and 42% to 66% and 26%, respectively. CONCLUSIONS: Low HDL-C is the most frequent dyslipidemic disorder in patients with poorly controlled insulin-treated type 1 diabetes, and a high proportion show LDL-C levels requiring intervention. Less favorable lipid profiles could explain the absence of sex protection in diabetic women. The improvement caused by glycemic optimization puts forward intensive therapy as the initial treatment of choice for dyslipidemia in poorly controlled type 1 diabetes.

Marathon runners presented lower serum cholesteryl ester transfer activity than sedentary subjects.

Acute exercise promotes raised HDL cholesterol concentrations by lipolysis stimulation, but this effect is insufficient to explain the more permanent HDL increases seen during regular exercise. During training periods in a group of marathon runners, we measured lipid transfer protein I (LTP-I)-mediated cholesteryl ester transfer activity (CETA) and its relationship to their HDL concentrations. Runners of both sexes showed significantly lower CETA values than those of sedentary controls. Male runners also had significantly lower serum concentrations of triglyceride, VLDL cholesterol and apolipoprotein B, and significantly higher concentrations of HDL cholesterol and apolipoprotein A-I than male controls. Results indicate that regular practice of aerobic exercise promotes modifications of lipoprotein metabolism related not only to lipolysis, but also to lower CETA. Such modifications are associated with reduced risk of atherosclerosis.

Effect of cyclosporin on plasma lipoprotein lipase activity in rats.

The effects of cyclosporin on plasma lipoproteins and lipoprotein lipase (LPL) activity were studied in rats treated with different doses of the drug for periods ranging between 7 and 30 days. The treatment with cyclosporin resulted in an increase in plasma triglycerides and non-HDL-cholesterol, and a dose and time-dependent decrease of LPL activity and HDL-cholesterol, mainly because of a fall in the HDL2-cholesterol subfraction. The decrease of LPL activity was positively correlated (p < 0.01) with plasma HDL-cholesterol and HDL2-cholesterol and negatively with plasma triglycerides and non-HDL-cholesterol (p < 0.01). Our results indicate that the decrease in plasma LPL activity may be responsible for the increase in plasma triglycerides and the decrease in plasma HDL-cholesterol found in rats under cyclosporin treatment.

Circulant anti-triiodothyronine antibodies in a patient with Graves' disease: effects on measurement of T3 with different RIA procedures.

High levels of triiodothyronine have been found in a patient with Graves' disease caused by circulating antibodies able to bind specifically with serum triiodothyronine. High values found were due to the interference of the endogenous antibody with the conventional techniques of radioimmunoassay used for the evaluation of the hormone. An analytical pattern to identify these antitriiodothyronine antibodies is described.

Lipoprotein abnormalities in patients with asymptomatic acute porphyria.

There have been discrepancies in reports of total cholesterol and low density lipoprotein (LDL)-cholesterol levels in patients with acute porphyria. Some studies have found that acute porphyria patients have increased levels while others do not. The aim of this study has been to evaluate the lipid profile in a series of patients with acute porphyria, in order to help clarify these differences. Serum lipoprotein levels were studied in 30 patients (25 women and five men; age:38+/-10 years) with asymptomatic acute porphyria. Controls were 30 healthy volunteers matched for age and gender. For 13 patients and 15 controls, lipoprotein lipase and hepatic lipase activities were determined. Patients exhibited increased levels of total-cholesterol, LDL-cholesterol, high density lipoprotein (HDL)-cholesterol and apolipoprotein (apo)-A1 compared with controls (P4 mmol/l in 15 patients (50%). Levels of total triglycerides, very low density lipoprotein (VLDL)-triglycerides, VLDL-cholesterol, apo-B and lipoprotein(a) were similar in patients and controls. The hepatic lipase activity tended to be lower in patients than controls (33.8+/-17.7 vs. 50.4+/-23.0 pkat/ml; P=0.05). In conclusion, in patients with asymptomatic acute porphyria an increase of total and LDL-cholesterol was found. The cardiovascular risk conferred by this factor may be attenuated by increased HDL-cholesterol and apo-A1.

Lipoprotein compositional abnormalities in type I diabetes: effect of improved glycaemic control.

Major lipoprotein mass and composition were assessed in 45 subjects with insulin dependent diabetes mellitus (IDDM), before and after 2 months of intensive insulin therapy (IIT) and in 40 healthy control subjects. As compared to the control group, diabetic subjects at baseline had higher low density lipoprotein (LDL) and lower high density lipoprotein (HDL) masses. Expressing each lipoprotein constituent as a percent of total lipoprotein mass, very low density lipoprotein (VLDL) of diabetic patients was enriched in cholesterol and phospholipid and depleted in triglyceride and protein; IDL had higher triglyceride and phospholipid and lower cholesterol and protein proportion; LDL was depleted in protein and enriched in triglyceride; HDL was depleted in protein and enriched in triglyceride, cholesterol and phospholipid. After 2 months of IIT, HbA1c fell from 10.3 +/- 2 to 7.5 +/- 2% (P < 0.0001) and so did VLDL mass, which was lower than in control subjects. In addition, LDL and HDL masses, as well as triglyceride and cholesterol proportion in IDL particles normalized. The other compositional abnormalities improved without complete normalization. Thus, intensive insulin therapy in IDDM subjects brought quantitative lipoprotein alterations to normal even subnormal range, while most of the composition abnormalities improved without reaching complete normalization.

Involvement of protein kinase C in the supersensitivity to 5-HT caused by oxidized low-density lipoproteins.

The effect of native (n-LDL) and oxidized (ox-LDL) low-density lipoproteins and lysophosphatidylcholines (LPCs) on: (1) vasodilator responses induced by acetylcholine (ACh) in intact rabbit aorta segments, and (2) vasoconstrictor responses to serotonin (5-HT), and potassium (K+) in endothelium denuded segments was investigated. In intact vessels, 100 microg/ml ox-LDL did not modify ACh-induced relaxation, while it was diminished by 300 microg/ml ox-LDL and abolished by 50 microM LPCs. In contrast, this relaxation was unaltered by n-LDL (100 or 300 microg/ml). In deendothelialized arteries, 100 and 300 microg/ml n-LDL as well as 50 microM LPCs did not modify the contractions induced by 5-HT or K+, while 100 or 300 microg/ml ox-LDL increased the 5-HT-induced contraction, without altering those induced by 75 mM K+. Incubation with 100 or 300 microg/ml ox-LDL increased the contractile response to the protein kinase C (PKC) activator phorbol 12,13-dibutyrate (PDB) (0.1-1 microM) in a concentration-dependent manner, which was blocked by staurosporine (0.1 microM), and unaltered by (50 microM) calphostin C or (50 microM) chelerythrine, the three are PKC inhibitors. Preincubation with 0.05 microM PDB increased the contraction elicited by 5-HT, while staurosporine decreased the PDB-induced contraction, and prevented the 5-HT response increase caused by 300 microg/ml ox-LDL. These results suggest that only ox-LDL reduces endothelium-dependent relaxation and elicits PKC activation, and that this activation mediates, at least in part, the vasoconstrictor response to 5-HT.

[Seasonal variations of lipids and arterial pressure]. / Variación estacional de lípidos y presión arterial.

BACKGROUND: The presence of a seasonal variation in serum lipids and blood pressure is often described in the literature. METHODS: With the aim of analyzing this seasonal influence blood pressure and lipid (total cholesterol and cholesterol corresponding to different lipoprotein, triglycerides and AI and B apolipoprotein families) values were studied over 12 months in 36 normotense healthy males (mean age 36 +/- 6 years), a third of whom presented diverse base lipid alterations. A variance analysis of the relative intraindividual values (to study monthly differences) was carried out and a Student's t test was performed for the absolute values and grouped into two periods (summer and winter) and according to two categories (normal and hyperlipemic). RESULTS: No significant modification was observed in any of the parameters studied with the exception of the intrapersonal variation coefficient of the triglycerides which was significantly higher in the hyperlipemic individuals. CONCLUSIONS: In the population studied no seasonal modification was observed in blood pressure or different lipid concentrations analyzed. The slight variation of temperature observed and the elevated sunstroke in Spain in addition to the youth of the population studied may explain the lack of seasonal variation.

[Analysis of evaluation process of research projects submitted to the Fondo de Investigación Sanitaria, Spain]. / Análisis del proceso evaluador de los proyectos de investigación en el Fondo de Investigación Sanitaria.

BACKGROUND: At the present time it seems very clear that research improvement is both an unquestionable fact and the right way to develop technological innovation, services and patents. However, such improvement and corresponding finances needs to be done under fine and rigorous evaluation process as an assessment tool under which all the research projects applying to a public or private call for proposals should be submitted to assure a coherence point according to the investment to be made. At this end, the main target of this work has been focused to analysis and study the evaluation process traditionally made by Fondo de Investigación Sanitaria (FIS) as well as to propose most adequate modifications. MATERIAL AND METHOD: A sample of 431 research projects corresponding to year 1998 proposal was analysed. The evaluation from FIS and ANEP (National Evaluation and Prospective Agency) was evaluated and scored (evaluation quality) in its main contents by 3 independent evaluators, the showed results submitted to a comparative frame between these agencies at indoor (FIS) and outdoor (FIS/ANEP) level. RESULTS: FIS evaluation had 20 commissions or areas of knowledge. The analysis indoor (FIS) clearly showed that evaluation quality was correlated to the assigned commission (F = 3.71; p < 0.001) and to the time last of the researched proposal (F = 3.42; p < 0.05) but no related to the evaluator. On the other hand, the quality of ANEP evaluation showed a correlated dependency of the three mentioned facts. In all terms, the ANEP evaluation was better than FIS for the three years time projects, but in did not show significant differences in one or two years time projects. In all cases, the evaluation with final results as negative (financing denied) showed an average quality higher than positive evaluation. CONCLUSIONS: The obtained results advice about the convenience of making some changes in the evaluative structure and to review the sort of FIS technical commissions focusing an improvement of the evaluation process.

[Lipid profile of the Spanish population: the DRECE (diet and risk of cardiovascular disease in Spain) study. DRECE study group]. / Perfil lipídico de la población española: estudio DRECE (Dieta y Riesgo de Enfermedad Cardiovascular en España). Grupo de estudio DRECE.

BACKGROUND: In Spain the mortality rate due to cardiovascular disease (CVD) is relatively low compared to that of other developed countries. Until now few epidemiological studies have been performed among the global Spanish population to evaluate a relation between CVD risk factors and the lipid profile that could justify our privileged situation. For, this reason, the DRECE study was designed to know the situation at present in Spain respect to the risk of suffering from CVD in particular, the lipid profile. POPULATION AND METHODS: This study included 4,787 subjects (2,324 males and 2,463 females) with an age ranging from 5-60 years, representative of the total Spanish population with these characteristics during the period from 1992 to 1994. Medical history was made for all participants, who also underwent a physical examination. The following parameters were determined: total cholesterol (TC), triglycerides, high-density lipoproteins cholesterol HDLc, cholesterol transported by low-density lipoproteins, LDLc (estimated by the Friedewald's formula), apolipoprotein AI and apoliprotein B (immunoturbidimetry). RESULTS: The results obtained and expressed in mean (SD) show that, although the population has total cholesterol concentrations (190.1 [42.4] and 192.8 [44.8] mg/dl for females and males, respectively) and LDLc (113.9 [37.9] and 117.5 [38.1] mg/dl for females and males, respectively) with values as high as those found in developed countries, the HDLc concentrations (58.6 [13.2] and 51.5 [13.4] mg/dl for women and men, respectively) are also increased and this could be the reason why the mortality rate in Spain caused by CVD is lower than in other countries. CONCLUSIONS: The finding of high HDLc levels and their antiatherogenic role could justify that, at best in part, the rate mortality in Spain is lower than in other developed countries.

[Phenotypic expression of Lp(a) in Spanish children and adolescents]. / Expresión fenotípica de la Lp(a) en niños y adolescentes españoles.

BACKGROUND: To know the distribution of phenotypes Lp(a) in an young population. METHODS: Lipoprotein levels, lipoprotein(a), apolipoproteins and the Lp(a) phenotypes were determined in 105 children, selected according to their cholesterol concentrations. RESULTS: The Lp(a) concentrations were significantly higher in group with low molecular weight respect to group with high molecular weight. The most frequent isoform was S3. CONCLUSIONS: The Lp(a) concentrations correlate inversely with the molecular weight of Apo(a) isoforms.

[Lipoprotein profile in children and adolescents of the Autonomous Community of Madrid]. / Perfil lipoproteico en niños y adolescentes de la Comunidad Autónoma de Madrid.

BACKGROUND: The aim of study was to know the lipoproteins distribution in children and adolescents from the Autonomous Community of Madrid, Spain, and to compare with other studies. MATERIAL AND METHODS: The sample included 3,635 children and adolescents (1,853 males and 1,782 females), 4 to 18 years of age. We measured total cholesterol and triglyceride levels with enzymatic methods, the HDL-cholesterol concentration in the supernatant after precipitation of the rest of the lipoproteins, and LDL-cholesterol concentrations were calculated by Friedewald formula. RESULTS: Total cholesterol levels were 174 +/- 25 mg/dl (4.50 +/- 0.64 mmol/l), triglycerides 60 +/- 24 mg/dl (0.67 +/- 0.28 mmol/l), LDL-cholesterol 100 +/- 22 mg/dl (2.59 +/- 0.58 mmol/l), HDL-cholesterol 61 +/- 13 mg/dl (1.6 +/- 0.34 mmol/l). 19.23% of the children studied had cholesterol levels above 200 mg/dl (> 5.18 mmol/l), and 41.5% of them had levels higher than 180 mg/dl (> 4.66 mmol/l). CONCLUSIONS: The cholesterol levels as well as the HDL-cholesterol levels in the student population of Madrid, Spain, were higher when compared to other studies. Less variation was found in the LDL-cholesterol concentrations.

[Tangier disease: study of the first case in Spain]. / Enfermedad de Tangier: estudio del primer caso español.

The clinical, biochemical and pathological studies of the first case of Tangier's disease that, to our knowledge, has been detected in Spain are reported. The patient had all the characteristic features of the disease: hypercholesterolemia with very pronounced reduction of plasmatic high density lipoproteins, splenomegaly, orange yellow tonsils and peripheral neuropathy. In addition, he had pneumonia and pancytopenia. Neurological examination and computed tomography suggested cerebral involvement, not previously reported in this condition. Biopsies demonstrated lipid accumulation in the reticuloendothelial cells of diverse localizations and in Schwann's cells.

[Molecular biology of familial hypercholesterolemia]. / Biología molecular de la hipercolesterolemia familiar.

The causes and mechanisms of production of familial hypercholesterolemia at molecular level is reviewed. This is a monogenic hereditary disease that frequently affects the human being it is one of the supports in the existing relationship between hypercholesterolemia and acute heart infarction. Important advances in the diagnosis and treatment of this disease have been achieved with the profound knowledge of the biochemical alteration.

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

Pseudo-hypertriglyceridaemia or hyperglycerolemia?

Hyperglycerolemia is a very rare genetic disorder caused by glycerol kinase deficiency. Although usually is presented unexpectedly in routine checks, there are severe forms, especially in children. In general, glycerol and glycerol kinase activity analyses are not included in routine laboratory determination. Glycerol presents positive interferences with some biochemical analytic techniques, e.g. in serum triglycerides and plasma ethylene glycol levels assays. Here, we report a Spanish patient with a pseudo-hypertriglyceridaemia, a falsely elevated triglycerides concentration that was not corrected with lipid-lowering therapy for 3 years.

Under-recognized renal insufficiency in hospitalized patients: implications for care.

BACKGROUND: The consequences of undetected low glomerular filtration rate (GFR) are important in hospitalized patients who receive potentially nephrotoxic drugs or undergo major surgery. This study estimated the prevalence of estimated GFR (eGFR) <60mL/min/1.73m(2) in hospitalized patients. METHODS: This cross-sectional descriptive study included 14,658 adults hospitalized at 10 centers in Spain. Serum samples were analyzed for hemoglobin, creatinine, albumin and urea nitrogen. eGFR was estimated using Modification of Diet in Renal Disease (MDRD) 4 or MDRD IDMS, and MDRD 6 when serum albumin and BUN were included (n=8611). Individuals were classified as having GFR>or=60mL/min/1.73m(2), stages 3, 4 and 5 (GFR 30-59, 15-29 and <15mL/min/1.73m(2), respectively). Additionally, stages 3a and 3b (GFR 45-59 and 30-44mL/min/1.73m(2), respectively) were assessed. RESULTS: MDRD 4 eGFR showed that 28.3% of patients had renal insufficiency stages 3-5 and 14.2% had stages 3b, 4 or 5, which represents important-severe renal deterioration. Forty-three percent of patients with stages 3-5 had hemoglobin or=60mL/min/1.73m(2). A good correlation was observed between eGFR MDRD 4 and MDRD 6. CONCLUSIONS: A high percentage of hospitalized patients in Spain have deteriorated renal function stages 3-5. Using eGFR equations to assess eGFR could identify more hospitalized patients with renal insufficiency, potentially leading to improved care.