The influence of egg consumption on the serum cholesterol level in human subjects.

The influence of whole fresh eggs on the serum cholesterol level in men and women was studied independently in hospitalized patients in Sofia, Prague and Urbana-Champaign. The patients were fed two eggs or the equivalent of two eggs in a custard base or milk shake in addition to the foods that were consumed in their diet pattern. The serum cholesterol level was determined before and at periods varying from 5 hr to 54 days after the consumption of the eggs. The mixed fatty acid composition of the total lipids in the serum and the erythrocytes was also determined. In the majority of patients, the serum cholesterol level did not change significantly 5 hr after the consumption of 465 mg of cholesterol in an egg custard base or milk shake or after up to 54 days of continued consumption of two whole eggs per day. The serum cholesterol level of some subjects increased and others decreased at all three experimental sites. A comparison of the mixed fatty acid composition of the total serum lipids obtained from men and women who had received treatment for other reasons than cardiovascular disease with those that had been treated for cardiovascular disease indicated that the serum from both groups contained a substantial amount of polyunsaturated fatty acids. The lipids extracted from the red blood cells obtained from patients in Urbana-Champaign and Sofia did not differ significantly in linoleic and arachidonic acid content.

Rate of LCAT-mediated cholesterol esterification and serum lipids during etiroxate therapy in hyperlipoproteinemia.

Changes in the rate of the plasma cholesterol ester production mediated by lecithin: cholesterol acyltransferase (LCAT, E.C. 2.3.1.43) were examined in 15 patients suffering from types II and IV HLP who had been treated for 14 weeks with etiroxate. Whereas the plasma cholesterol concentration decreased significantly only in the initial phase of the therapy, the rate of cholesterol esterification increased gradually and attained at the end of the study a value exceeding by 50% the initial level. The final fractional turnover rate nearly equalled that characteristic for the control group of healthy subjects, in spite of the fact that the concentration of plasma cholesterol in the diseased subjects was higher by 50-100%. Triglyceride concentration decreased only transitorily in the course of the therapy with etiroxate. It is concluded that etiroxate is likely to normalize the rate of cholesterol turnover in the endogenous pool.

Serum linoleic acid and cardiovascular death in postinfarction middle-aged men.

Linoleic acid in serum total lipids was the first variable in the stepwise regression analysis of metabolic, nutritional and cardiovascular factors in a secondary preventive study of postinfarction middle-aged men. It was followed in the regression analysis where the dependent variable was cardiovascular death by previous myocardial infarction, heart volume index and hyperlipoproteinaemia. Linoleic acid was the only fatty acid entering the regression. Unlike other fatty acids, it exhibited by its low percentage an accumulation of deaths. The decreased percentage of linoleic acid was also evident in the comparison of fatty acid patterns of cardiovascular deaths to age- and triglyceride-matched men free from ischaemic heart disease. This study confirms prospective associations found in previously healthy men. Conclusions are drawn about the relevance of low serum linoleic acid to long term prognosis after MI.

Metabolic effects of omega-3 fatty acids in type 2 (non-insulin-dependent) diabetic patients.

The metabolic effects of a 3-week dietary supplement of a fish oil concentrate was examined in mildly obese, normotriglyceridemic men with non-insulin-dependent diabetes mellitus (NIDDM) treated with hypoglycemic agents (n = 20). Patients were randomized into two groups, receiving 15 ml per day of fish oil (Martens Oil, Norway) containing 3.1 g of omega-3 fatty acids (FA) (n = 10) or placebo (n = 10). Whereas fish oil led to the expected increase in the ratio of omega-3 to omega-6 FA in serum phospholipids, reflecting the increase in omega-3 FA intake, it did not alter fasting or mixed meal stimulated blood glucose, plasma insulin, and C-peptide concentrations. No changes in insulin action were noted, estimated by the metabolic clearance rates of glucose at plasma insulin levels of approximately 100 microU/ml and 1,400 microU/ml during a hyperinsulinemic, isoglycemic clamp; no changes were seen in insulin binding to erythrocytes. We conclude that during short-term administration, no adverse effects of low dose fish oil on glucose homeostasis were found in mildly obese NIDDM patients treated with oral hypoglycemic agents.

Fatty acid composition of serum lipids and erythrocyte membranes in type 2 (non-insulin-dependent) diabetic men.

The fatty acid (FA) composition of serum lipids and erythrocytes was studied in 21 men with non-insulin-dependent diabetes mellitus (NIDDM) and in 14 normal subjects matched for age, sex, body weight, and dietary intake. Lower levels of linoleic acid and higher levels of highly unsaturated FA (daughter) of n-3 and n-6 family FA, reflected in a higher unsaturation index, were found in serum phospholipids (S-PL), in phospholipids of erythrocyte membranes (ery-PL), and in serum cholesterolesters (S-CHE). The unsaturation index of serum phospholipids significantly correlated with glycosylated hemoglobin A1c (P less than .05) and blood glucose levels after glucose load (P less than .001). The results suggest that elongation and desaturation of essential FA (linoleic acid in particular) are increased. The above changes may be associated with accelerated atherosclerosis in type 2 diabetics.

Insulin secretion and insulin action related to the serum phospholipid fatty acid pattern in healthy men.

In order to decide whether the phospholipid fatty acid pattern is related to variables determining glucose tolerance, 11 healthy volunteers with normal glucose tolerance were studied. The relationship was evaluated between the proportions of individual fatty acids (FA) in serum phospholipids and (1) insulin secretion, determined by fasting and postglucose plasma insulin levels, and (2) in vivo insulin action, assessed as metabolic clearance rates of glucose during euglycemic clamp studies at two insulin concentrations of approximately 70 microU/mL (MCRglu70) and 500 microU/mL (MCRglu500). It was found that both insulin secretion and insulin action are significantly related to the ratio of omega-6 class essential FA to saturated FA in serum phospholipids. An increase of this ratio is associated with a decrease in total insulin response (r = -0.84, P less than .01), and an increase in MCRglu70 (r = .66, P less than .05) and MCRglu500 (r = .82, P less than .01). The data presented support the hypothesis that phospholipid FA composition might play a role in blood glucose regulation.

Effect of acute hyperinsulinemia on fatty acid composition of serum lipids in non-insulin-dependent diabetics and healthy men.

The fatty acid pattern of serum phospholipids, cholesteryl esters, triglycerides and free fatty acids was measured before and after a 5-h two-step euglycemic hyperinsulinemic clamp (75 and 1400 microU/ml) in 21 non-insulin-dependent diabetics and 14 age-, weight-, and sex-matched healthy controls. Acute hyperinsulinemia was associated with a statistically significant increase in essential fatty acid and a decrease in non-essential fatty acid contents in triglycerides while the levels of serum triglycerides and free fatty acids dropped in both groups. The fatty acid composition of phospholipids and cholesteryl esters remained unchanged as did the levels of serum phospholipids, total cholesterol and HDL cholesterol.

Insulin binding to erythrocytes and fatty acid composition of erythrocyte membrane phospholipids in healthy men.

The relationship between specific insulin binding to insulin receptors on erythrocytes and erythrocyte membrane phospholipid fatty acid pattern was evaluated in 11 healthy men. A significant negative correlation between insulin binding and the proportion of w-6 family essential fatty acids, especially linoleic acid (r = -0.82, p less than 0.01) and arachidonic acid (r = -0.73, p less than 0.05) in erythrocyte membrane was found. On the other hand significant positive correlation between insulin binding and the content of nonessential fatty acids (r = +0.65, p less than 0.05) was seen. Data presented support the hypothesis that the fatty acid composition of membrane phospholipids may modify properties of insulin receptors.

Interrelationship between glucose and fat utilisation during simultaneous IV administration of glucose and lipid emulsion in healthy man.

In order to evaluate the interaction between glucose and fat utilisation during parenteral nutrition, we studied 12 healthy volunteers under three different conditions: While Intralipid infusion does not alter the glucose utilisation, measured by metabolic clearance rate of glucose at an insulin level of about 80 uU/ml (MCR(glu)submax) 11.3 +/- 1 v.s. 11.48 +/- 0.9 ml/kg/min) and the sensitivity index, it decreases glucose utilisation at an insulin level of about 550 uU/ml (MCR(glu)max) (17.8 +/- 1.3 v.s. 15.9 +/- 0.9 ml/kg/min, p < 0.05) suggesting postreceptor alterations in insulin action. Simultaneous administration of Intralipid with glucose and insulin is associated with a smaller increase in serum triglycerides than the infusion of Intralipid alone (2.56 +/- 0.4 v.s. 5.44 +/- 0.5 mmol/lm p < 0.001). We conclude that, when infused at standard rates, Intralipid does not decrease glucose utilisation significantly and, at the same time, its own clearance is enhanced by glucose and insulin.

Glucose and fat utilization during intravenous administration of glucose and lipid emulsion in non-insulin-dependent diabetic patients.

To evaluate the clinical significance of substrate competition in the insulin-resistant state, we measured glucose and lipid utilization in 10 non-insulin-dependent diabetic patients during an isoglycemic hyperinsulinemic (approximately 75 and approximately 1500 mU/L) clamp without and with the concomitant infusion of Intralipid (0.15 g triglycerides.kg-1 x h-1) and during Intralipid infusion only in combination with indirect calorimetry. We found that a lipid emulsion does not alter the metabolic clearance rates of glucose at insulinemias of approximately 75 mU/L (5.58 +/- 2.56 vs. 6.03 +/- 2.43 ml.kg-1 x min-1) and approximately 1500 mU/L (13.55 +/- 3.17 vs. 13.75 +/- 4.36 ml.kg-1 x min-1) and it does not change oxidative and nonoxidative glucose disposal rates. Insulin and glucose attenuate the Intralipid-induced increase in serum triglycerides, free fatty acids, and lipid oxidation. We conclude that, whereas Intralipid infused at a standard rate does not decrease glucose utilization under hyperinsulinemic conditions, its own removal from the plasma is enhanced by glucose and insulin in non-insulin-dependent diabetic patients.

[Insulin resistance, hypertension and atherosclerosis]. / Inzulinová rezistence, hypertenze a ateroskleróza.

At least one fourth of the population has an elevated serum insulin concentration. In the majority diabetes is not involved but one of the symptoms of insulin resistance. The picture comprises also signs of the metabolic syndrome (impaired carbohydrate tolerance, dyslipidaemia and hypertension), as well as other less well known manifestations such as hyperuricaemia, the android type of obesity, impaired fibrinolysis, changes in the fatty acid composition. Manifestations of IHD may be also present. The gene is transmitted in families and hyperinsulinaemia may precede all other symptoms. There are procedures how to control insulin resistance: therefore it is essential to learn how diagnose its comprehensive clinical picture and provide treatment before life endangering complications develop.

[Prevention of atherosclerosis in diabetics]. / Moznosti prevence aterosklerózy u diabetiku.

The high prevalence of atherosclerotic (macrovascular) complications in diabetes (1.5-6x higher than in non-diabetics) stimulated evaluation of new pathogenetic findings which could have an impact on prevention. In type 1 diabetics the development of nephropathy is a factor hastening the development of macroangiopathy. In type 2 diabetics on whom attention is concentrated at the moment interaction of various metabolic deviations is involved which include changes of lipoproteins (drop of HDL, changes in the size and composition of LDL), insulin resistance and glycosylation of proteins. There is an enhanced tendency to lipoprotein oxidation (LDL) which promote the development of cholesterol rich plaques in the arterial walls. Their rupture may cause occlusion and ensuing risks for life. Possibilities of prevention are not adequately made use of. This is due to a tendency to underrate the serious character of type 2 diabetes and also the high percentage of diabetics where the disease was diagnosed late. The metabolic syndrome which develops as a result of insulin resistance precedes for years manifestations of diabetes. Its detection makes it possible to screen subjects at risk, some of whom develop diabetes. At the same time it is also a pathogenetic factor of macrovascular complications. It leads to the cumulation of a number of risk conditions. More effective prevention can be implemented by intervention of all associated risk factors (smoking, hypertension), in the application of lifestyle provisions of energy reduction by promoting physical activity and by a rational diet (diabetes, obesity, hyperlipidaemia). The justification of pharmacotherapy for the high risk groups of diabetics with hyperlipidaemia is supported by results of recently published investigations where statins were used. For the sub-population of subjects at risk the perspective should be screening of risk factors, early diagnosis of diabetes, education, continuous primary care, comprehensive prevention using lifestyle provisions as well as advances in modern pharmacotherapy.

[Angiotensin converting enzyme inhibitors increase insulin sensitivity in offspring of families with hypertension even after active interventions. Results of a clamp study]. / Inhibitory angiotenzin konvertujícího enzymu zvysují citlivost na inzulin i po aktivní intervenci u skupiny potomku z rodin hypertoniku. Výsledky clampové studie.

BACKGROUND: Altered insulin sensitivity is the basis for the syndrome of insulin resistance generally known as metabolic syndrome. Its importance is due to the cumulation of a number of risk factors of IHD. The familial disposition for the syndrome may be the cause of medical complications also in families of hypertensive patients. The objective of the study was to provide evidence of the possible change of insulin sensitivity in a group of middle-aged men from families with disposition for hypertension two years regime therapy and subsequent administration of angiotensin converting enzyme inhibitor (ACEI). METHODS AND RESULTS: Using the method of hyperinsulin euglycaemic clamp a group of 15 offspring of hypertensive subjects (PHT) were examined who at the time did not differ in basic indicators from a control group of 18 men of similar age. The authors found lower values of glucose consumption (Msubmax), metabolic glucose clearance (MCRsubmax), however statistically significant differences were found in the indexes of insulin sensitivity SI (SI: 46.51% +/- 11.77% vs. 54.28% +/- 7.79%, p < 0.02) and ISI (ISI: 6.6% +/- 3.99% vs. 9.88% +/- 5.05%, p < 0.01). After six weeks of ACEI administration (enalapril 10 mg) the insulin sensitivity in PTH increased significantly in the majority of investigated parameters (MCRsubmax to 9.7 +/- 3.04 mg/kg.min-1, p < 0.05), in indexes of insulin sensitivity (SI to 54.83 +/- 12.9, p < 0.001 and ISI to 9.34 +/- 4.78 mg/kg/min-1, p < 0.01). The insulin sensitivity in PHT who were given ACEI exceeded in some indicators the coresponding values in subgroup of controls which was without medication. After ACEI administration the renin secretion increased and the levels of the plasminogen activator inhibitor (PAI-1) did not change. CONCLUSIONS: ACEI administration improved the insulin sensitivity in a group of 15 men from families of hypertensive subjects. It exceeded the effect of diet and change of regime which had already influenced the symptoms of metabolic syndrome in a favourable way.

[Small doses of the resin Colestid in the treatment of hyperlipoproteinemia]. / Malé dávky pryskyrice Colestidu v lécbe hyperlipoproteinémií.

To a group of 24 subjects with hypercholesterolaemia (hyperlipoproteinaemia type II) for a period of three months the non-absorbable resin Colestid was administered in order to reduce levels of atherogenic lipids and lipoproteins. The Colestid doses were graded from 5 g in the first month to 10-15 g during the third month. Reduction of cholesterol levels and the LDL fraction was significant already during the first month of treatment. The greatest reduction of LDL cholesterol was 25% and of total cholesterol 15%. A favourable effect was recorded also in HDL cholesterol which increased. The rise of triacylglycerols was not significant. Differences in the serum lipid response or their fractions did not depend on sex (15 women, 9 men), the clinical symptomatology (IHD) or family-history of atherosclerosis or concurrent administration of fibrates (Lipanthyl in 7 patients). In view of the small doses the symptomatology of side-effects was poor. Four patients, however, did not complete three months of treatment. With regard to the economical aspect of therapy and the favourable effect of small doses the authors draw attention to this experience which can be used as a basis also when using combinations with other preparations of antihypercholesterolemic therapy in those patients where an adequate reduction of cholesterol and its LDL fraction is not achieved.

[Atherosclerotic changes in the carotid artery detected by ultrasound in newly diagnosed type II diabetics]. / Aterosklerotické zmeny na arteria carotis prokázané ultrazvukovým vysetrením u nove zjistených diabetiku II. typu.

In a group of 107 middle-aged men with newly detected diabetes type II the authors investigated by means of a double ultrasonographic examination the incidence of atherosclerotic changes of the carotid artery. The incidence of atherosclerotic lesions on the carotid artery was relatively high (44% of the group), the majority of arterial stenoses was, however, without haemodynamic impact. A frequent finding were calcifications in the sclerotic plaques. Affection of the carotid artery was significantly frequently associated with ischaemic heart disease and ischaemia of the lower extremities. As compared with the results of examinations of the lipoprotein and carbohydrate metabolism, the authors found in men with affected carotid arteries as compared with not affected subjects significantly higher triacylglycerol levels, higher levels of circulating insulin and a higher ratio of total to HDL cholesterol.

[Glycemia increases during treatment of hypertension. 13 years' experience in the treatment of middle-aged men, randomized for treatment with beta blockers and diuretics]. / Glykémie se zvysuje pri lécbe hypertenze. Zkusenosti z 13 let trvající lécby skupiny muzu stredního veku, randomizované k lécbe betablokátory, resp. diuretiky.

BACKGROUND: Hypertension can no longer be evaluated only with regard to the increase of blood pressure; its clinical picture must comprise also metabolic changes with originate from insulin resistance. METHODS AND RESULTS: The authors submit some incentives from a 13-year long therapeutic follow-up of hypertension in a group of 54 middle-aged men suffering from essential hypertension. From a control group of 38 men they differed as regards blood pressure (174.2 +/- 13.2/112.9 +/- 7.0 mm Hg vs. 126.4 +/- 13.9/77.6 +/- 7.4 mm Hg, p < 0.001), body build (BMI = 28.0 +/- 3.4 kg/m2 vs 23.9 +/- 2.5 kg/m2, p < 0.001), waist/hip ratio 0.98 +/- 0.04 vs 0.94 +/- 0.04, p < 0.05, as well as uric acid serum levels (413.7 +/- 111.0 mumol vs. 362.6 +/- 65.9 mumol/l, p < 0.05) and HDL cholesterol (1.36 +/- 0.30 mmol/l vs. 1.51 +/- 0.48 mmol/l, p < 0.05). However, the fasting blood sugar levels did not differ (5.2 +/- 0.7 mmol/l vs 5.1 +/- 0.6 mmol/l). Although the index of insulin resistance was elevated (6.6 +/- 2.1 vs. 2.84 +/- 1.6, p < 0.01). The blood sugar level rose steadily and reached a level of 18.7% +/- 14.8% (p < 0.01). The increments of the blood sugar level correlated with changes in body weight (1.2% +/- 6.1% r = 0.535, p < 0.001), TAG (4.0% +/- 5.6% r = 0.332, p < 0.05) and the fasting baseline blood sugar levels (r = 0.551, p < 0.001). The mentioned variables contributed to the prediction of increments of the blood sugar level in multiple regression (determined coefficient R2 = 0.51). No relationship with the type of treatment was revealed. 11% of the patients developed during the investigation period symptoms of type 2 diabetes. The development of diabetes could be predicted on the basis of three baseline variables- the BMI, the index of insulin resistance and the basal blood sugar level (logistic regression, r = 0.790. CONCLUSIONS: Hypertension is a constituent of the metabolic syndrome, although the rise of the blood sugar does not directly correlate with manifestation of type 2 diabetes, it is a warning that insulin resistance can influence the effectiveness of provisions of the therapeutic regimen, and last not least, also the development of type 2 diabetes.

[Life prognosis and macrovascular complications 10 years after diagnosis of type 2 diabetes]. / Zivotní vyhlídky a makrovaskulární komplikace deset let po zjistení diabetu 2. typu.

BACKGROUND: Diabetes mellitus which develops in middle age is a serious complication, although its impact is often underrated due to relatively few symptoms and independence on insulin. The authors decided therefore to evaluate in 132 men with recently detected type 2 diabetes serious complications, evaluate the prognostic power of indicators apparent at the time of development of diabetes on the general mortality and macrovascular complications which were manifested within 10 years after detection of diabetes. METHODS AND RESULTS: From a group of men, mean age 50.6 +/- 8.5 years, who were examined in 1985-1986 at the Clinic of Diabetology and Experimental Therapy, IKEM, during this period 20 died (15%). The total mortality correlated with systolic blood pressure (154 +/- 26.2 mm Hg vs 140.5 +/- 16.5 mm Hg, p < 0.05), blood sugar level (8.8 +/- 3.0 mmol/l vs 7.4 +/- 2.7 mmol/l, p < 0.05), alpha 2 globulin levels (6.4 +/- 1.2 vs 5.2 +/- 1.1 g/l, p < 0.01, family history of infarction (p < 0.01) and ischaemic changes on the ECG tracing (p < 0.05). In multiple logistic regression the role of systolic pressure, blood sugar level, family history of infarction and also HDL cholesterol in relation to the status after 10 years was confirmed (r = 0.5378). Clinically confirmed macrovascular complications were evaluated after 10 years in 91 of 112 living subjects. Signs of macroangiopathies (43%) were associated with a higher mean age (54.1 +/- 6.9 years vs 48.0 +/- 8.0 years, p < 0.001), elevated triacylglycerol levels (3.7 +/- 2.7 mmol/l vs 2.35 +/- 1.7 mmol/l, p < 0.01), reduced levels of HDL cholesterol (1.04 +/- 0.27 mmol/l vs 1.15 +/- 0.24 mmol/l, p < 0.05) and elevated Apo B levels (1.27 +/- 0.44 g/l vs 1.06 +/- 0.31 g/l vs p < 0.01). Only a group of 13 men which at the time when diabetes was detected had a history of cardiovascular complications the levels of C peptide were significantly elevated 120 min, after stimulation (2.57 +/- 0.74 pmol/ml vs 1.63 +/- 0.96 pmol/ml, p < 0.05). CONCLUSIONS: Components of the metabolic syndrome conditioned by insulin resistance of tissues are among factors which have an impact on the general mortality as well as on clinical symptoms of macroangiopathies.

[Serum insulin levels affect body constitution, blood pressure, serum lipids and cardiac dimensions. Observations in clinically healthy offspring from hypertensive families]. / Sérové koncentrace inzulinu ovlivnují telesnou stavbu, krevní tlak, sérové lipidy i srdecní rozmery. Pozorování u klinicky zdravých potomku hypertenzních rodin.

BACKGROUND: According to some work hypertension is in a pathogenetic relationship with hyperinsulinaemia or is considered to be the consequence of insulin resistance. It is, however, also known that there exists a familial predisposition for hypertension; according to genetic investigations half the family relatives can suffer from hypertension. In conjunction with these views on the pathogenesis of hypertension and its familial character the authors outlined the following objectives of their investigation: to test clinically and metabolically the condition of the offspring of probands with essential hypertension requiring systematic treatment. The authors investigated in particular indicators of body composition, insulin concentration and its relationship to serum levels and some indicators of lean body mass. METHODS AND RESULTS. There were 48 offspring (25 men and 23 women) from families of 30 probands suffering from hypertension. The mean age of the offspring was 38.4 +/- 7.8 years. They were compared with a group of 72 controls, mean age 35.8 +/- 8.2 years (36 men and 36 women) without a family history of hypertension and diabetes (t-test). The basal insulin concentration (IRI O' = 20.5 +/- 12.8 microU/ml, and 14.3 +/- 7.3 microU/ml resp., p < 0.01) and basal C peptide (O' = 0.59 +/- 0.31 pmol/ml and 0.50 +/- 0.20 pmol/ml resp., p < 0.05) were elevated. The offspring of probands with hypertension had a higher body weight (BMI = 25.3 +/- 3.5 kg/m2 and 23.3 +/- 2.5 kg/m2 resp., p < 0.001) a higher ratio of waist hip circumferences (0.94 +/- 0.1 and 0.87 +/- 0.1 resp., p < 0.001) similarly as blood pressure (131.5 mmHg +/- 11.8 mmHg and 116 mmHg +/- 13.3 mmHg resp., p < 0.001) and blood sugar level (5.29 +/- 0.61 mmol/l and 4.93 +/- 0.39 mmol/resp., p < 0.01). The authors also found differences in the serum cholesterol levels (5.9 +/- 1.3 mmol/l and 5.1 +/- 0.6 mmol/l resp., p < 0.01), HDL cholesterol (1.45 +/- 0.50 mmol/l and 1.65 +/- 0.60 mmol/l resp., p < 0.01) and triacylglycerol trends (1.66 +/- 1.54 mmol/l and 1.37 +/- 0.96 mmol/l resp., p < 0.1). On echocardiographic examination the cardiac dimensions were not enlarged, however, significant relations (linear regression) were proved in offspring in particular as regards the dimensions of the left ventricle and insulin (IRI O-left atrium p < 0.05, IRI 30-left atrium, p < 0.01. C peptide O-left atrium, p < 0.05). Between the body mass index, cholesterol, uric acid HDL-cholesterol the waist/hip ratio on the one side, the dimensions of the left atrium, thickness of septum and posterior wall (p < 0.01-0.001), between insulin and C peptide (p < 0.001) on the other side even closer relations were found. CONCLUSIONS: Elevated insulin concentrations may participate in the development of body composition, they influence the lipid transport and blood pressure in clinically healthy offspring of probands suffering from hypertension. The relationship between the insulin concentration and disposition towards enlargement of the left heart needs more detailed investigation.

[Hyperglycemia, hyperinsulinism, atherosclerosis]. / Hyperglykémie, hyperinzulinismus, ateroskleróza.

The paper deals with a group of 117 patients with clearly defined clinical signs of atherosclerosis following myocardial infarction appearing in middle age, analyzes relationship between indicators of saccharide metabolism and cardiovascular morbidity within a ten-year period, and discusses its potential cause. Fasting levels taken at 120 minutes after the administration of glucose and the sum of the fasting level and three stimulated levels of blood sugar, or insulin (IRI), were compared with 54 controls as well as within the group of patients. Compared with the control group, the patients had glycemia levels elevated. In the group of patient with ischaemic heart disease (glycemia levels especially the sum but also glycemias at 120 min.) were elevated in persons with signs of ischaemic disease of lower extremities, with hypertension, in cases with increased serum triacylglyceroles, with increased energy intake (including fasting levels). The sum of insulin kept increasing in cases with familial disposition to atherosclerosis, with clinical progression of atherosclerosis over a period of 5 years (non-fatal reinfarctions). This had a highly significant correlation with linoleic acid in total serum lipids suggesting correlation with cardiovascular morbidity. This finding stresses the necessity of a comprehensive view of deviations in sacharide metabolism, especially as regards the relationship between elevated glycemia and cardiovascular morbidity, and between insulin and mortality-causing factors.

[Insulin resistance and insulin secretion in type II non-obese diabetics]. / Inzulinová rezistence a sekrece inzulinu u diabetiku II. typu bez obezity.

BACKGROUND: Glucose tolerance depends essentially on insulin secretion and its action in target tissues. Diabetes mellitus type II (insulin-nondependent diabetes) is a disease conditioned by a dysbalance between insulin secretion and effect; it has not been decided whether the cause is insulin resistance or impaired insulin secretion, although a defect of insulin secretion for the manifestation of the disease is generally accepted. The purpose of the submitted study was to assess to what extent insulin secretion and its effect after an oral glucose load and a hyperglycaemic clamp is affected in different groups of non-obese patients with diabetes type II. METHODS AND RESULTS: The authors examined 21 men with diabetes type II (age 41 +/- 2.6 years, BMI 26.2 +/- 3.2, HbA1,c 9.4 +/- 2.9%) in the course of one year after detection of the disease, treated by diet alone. The second group was formed by 20 patients with diabetes type II (age 46.1 +/- 3.6 years, BMI 26.0 +/- 2.1, HbA1,c 6.94 +/- 1.6%) who suffered from diabetes for 5-10 years and who were treated by diet alone. The third group was formed by 32 diabetics type II (age 51.8 +/- 6.1 years, BMI 26.7 +/- 2.2, HbA1,c 8.7 1.2% +/-) who suffered from diabetes for 5-10 years and were treated with oral antidiabetics. The control group was formed by 42 healthy men matched for body weight and age (age 39.9 years, BMI 25.3, blood sugar level 4.8 mmol/l). Although the diabetic groups did not differ in the fasting blood sugar level (8.0-8.29-8.2 mmol/l), the glycosylated haemoglobin HbA1,c level is lowest in the group of diabetics treated by diet alone, similarly as the rise of the blood sugar level 120 mins, following oral administration of 75 g of glucose (10.3 mmol/l, as compared with 16.2 mmol/l and 15.5 mmol/l in the other groups). The authors found in all groups of diabetic patients, as compared with controls, a comparable drop of the insulin effect evaluated as the metabolic glucose clearance during an hyperinsulinaemic euglycaemic (5 mmol/l) or isoglycaemic (fasting blood sugar level) clamp, the insulin level being 75 microU/ml (controls 10.9 +/- 3.3 ml/kg.min., first group 5.35 +/- 2.7 ml/kg.min., second group 5.47 +/- 2.35 ml/kg.min., third group 5.38 +/- 2.1 ml/kg.min. The differences, as compared with controls, were significant in all groups, p < 0.01). At an insulin level of 1500 microU/ml the results are similar (controls 17.4 +/- 3.8 ml/kg.min., as compared with 13.3 +/- 3.3 in the first group, 13.3 +/- 3.0 in the second group and 12.5 +/- 3.0 ml/kg.min. in the third group: statistical significance in all three groups, as compared with controls, is p < 0.05). The authors did not reveal any differences in the specific insulin bond to insulin receptors of erythrocytes. The total glucose consumption during an isoglycaemic clamp in diabetics and a euglycaemic clamp in controls did not differ. In all diabetic groups, as compared with controls, higher C peptide values and insulin values (IRI) were found on fasting and a slower rise and longer persistence of higher levels after oral glucose administration, although an inadequate secretory response during the hyperglycaemic clamp in diabetics is apparent. Hyperinsulinism was significantly higher in the second group. The number of insulin receptors on erythrocytes, the affinity for insulin, regardless whether the receptors were free or occupied, did not differ significantly between groups. CONCLUSIONS: All investigated groups of type II diabetics had a comparable degree of insulin resistance which did not depend on the duration of diabetes, its compensation or the type of treatment. Although impaired insulin action was proved, the total glucose utilization in relation to hyperglycaemia is not reduced. The differences in the degree of glucose intolerance in the investigated groups of diabetics type II depend on the degree of impairment of insulin secretion.