Effect of Virtual Reality Therapy on Quality of Life and Self-Sufficiency in Post-Stroke Patients.

Background and Objectives: The consequences of stroke have a significant impact on self-sufficiency and health-related quality of life (HRQoL). Virtual reality (VR)-based rehabilitation has the potential to impact these modalities, but information on timing, volume, and intensity is not yet available. The aim of this randomized controlled trial (1:1) was to evaluate the impact of conventional rehabilitation combined with VR on self-care and domains of HRQoL in patients ≤6 months post-stroke. Materials and Methods: The intervention group completed a total of 270 min of conventional VR + rehabilitation sessions. The control group underwent conventional rehabilitation only. Primary assessments with the WHO disability assessment schedule 2.0 (WHODAS 2) questionnaire were conducted before rehabilitation (T0), after completion of the intervention (T1), and at the 4-week follow-up (T2); secondary outcomes included self-sufficiency and balance assessments. Results: Fifty patients completed the study (mean age 61.2 ± 9.0 years, time since stroke 114.3 ± 39.4 days). There were no statistically significant differences between the groups in WHODAS 2, self-sufficiency, and balance scores (p > 0.05). Conclusions: In the experimental group, there was a statistically significant difference in WHODAS 2, assessment of self-sufficiency, and balance scores before and after therapy (p < 0.05). VR appears to be a suitable tool to supplement and modify rehabilitation in patients after stroke.

The Role of Acute Rehabilitation during the COVID-19 Pandemic: A Retrospective Study in the Czech Republic.

In this retrospective study, we used data from the hospital information system (HIS) to evaluate the influence of the COVID-19 pandemic on rehabilitation care at the University Hospital of Ostrava (UHO). From March 2020 to December 2021, 5173 COVID-19 cases were hospitalized at UHO. Cases within individual groups and categories are shown in a flowchart. The average patient age was 64.9 ± 16.9 years. The mean BMI value was 30.6 ± 6.8 in the rehabilitated group, which was significantly higher compared to that among the non-rehabilitated cases 29.1 ± 6.9 (p < 0.001). Among the admitted patients, 16.6% required artificial pulmonary ventilation (APV), 1.8% extracorporeal membrane oxygenation (ECMO), and 11.9% high-flow oxygenation (HF). The days of rehabilitation ranged from 1-102 days. Among all rehabilitated patients, 92.0% (n = 1302) had a hospitalization duration ranging from 1-15 days and 8.0% (n = 114) longer than 15 days. Overall, rehabilitation care plays an important role in providing exercise, mobilization, and rehabilitation interventions to survivors of critical illness associated with COVID-19, enabling the early and functional return to home, and it must, therefore, be integrated into the clinical care of patients with COVID-19.

Comparison of performance and anthropometric parameters in paediatric competitive athletes during COVID-19 pandemic in the Czech Republic.

OBJECTIVES: In 2020, measures against the spread of COVID-19 were adopted, including nationwide school closures, restrictions on the free movement of persons and leisure time sports activities. The aim was to assess the impact of COVID-19-associated restrictions on the performance of paediatric and adolescent competitive athletes by comparing basic anthropometric and performance parameters. METHODS: The sample comprised 389 participants (115 girls, 274 boys). All participants were examined during regular preventive sports health checks from September to November 2019 and a year later. At the initial examination, the mean age of the entire sample was 12.2 ± 2.7 years (median 12.0, minimum 7.0; maximum 17.0). The examination consisted of a complete medical history and physical examination including maximal exercise testing on a leg cycle ergometer. RESULTS: In the entire sample, as well as in the boy and girl subgroups, body height, weight, body mass index (BMI), BMI percentile, and power output significantly increased according to a percentile graph for boys and girls in 2020. A reduction in power output (W/kg) was found. By 2020, W/kg dropped in 56.4% of the youngest participants (7-13 years), 75% of those aged 14-16 years and 64.9% of the oldest individuals (16-17 years). The percentage of the youngest children with power output reductions was statistically significantly lower than the percentages of the other age subgroups (p = 0.007). There were no significant differences in results between genders. CONCLUSIONS: Performance and anthropometric parameters worsened especially among older children. This should be reflected when planning epidemic measures in case of any similar situation in the future.

Determination of the prevalence and predictors of ventricular thrombus with assessment of the risk of systemic embolization to the CNS in patients after acute myocardial infarction using magnetic resonance imaging, echocardiography and cardiac markers - a prospective, unicentric, observational study.

BACKGROUND: Left ventricular thrombus (LVT) formation is one of the well-known and serious complications of acute myocardial infarction (AMI) due to the risk of systemic arterial embolization (SE). To diagnose LVT, echocardiography (TTE) is used. Late gadolinium-enhanced cardiovascular magnetic resonance (DE-CMR) is the gold standard for diagnosing LVT. OBJECTIVES: The aim of this observational study was to determine the role of transthoracic echocardiography and cardiac markers in predicting the occurrence of LVT compared with a reference cardiac imaging (DE-CMR) and to determine the risk of systemic embolization to the CNS using brain MRA. METHODS: Seventy patients after MI managed by percutaneous coronary intervention (localization: 92.9% anterior wall, 7% other; median age 58.7 years) were initially examined by transthoracic echocardiography (TTE, n=69) with a focus on LVT detection. Patients were then referred for DE-CMR (n=55). Laboratory determination of cardiac markers (Troponin T and NTproBNP) was carried out in all. Brain MRA was performed 1 year apart (n=51). RESULTS: The prevalence of LVT detected by echocardiography: (n=11/69, i.e. 15.9%); by DE-CMR: (n=9/55, i.e. 16.7%). Statistically significant parameters to predict the occurrence of LVT after AMI (cut off value): (a) detected by echocardiography: anamnestic data - delay (≥ 5 hours), echocardiographic parameters - left atrial volume index (LAVI≥ 32 mL/m2), LV EF Simpson biplane and estimated (≤ 42%), tissue Doppler determination of septal A wave velocity (≤ 7.5cm/s); (b) detected by DE-CMR: anamnestic data - delay (≥ 13 hours), DE-CMR parameters - left ventricular end-diastolic diameter (≥ 54mm). The value of cardiac markers (Troponin T and NTproBNP in ng/L) in LVT detected by echocardiography did not reach statistical significance. In LVT detected by DE-CMR, NTproBNP was statistically significantly increased at 1 month after AMI onset (no optimal cut-off value could be determined). There was no statistically significant association between the LVT detection (both modalities) and the occurrence of clinically manifest and silent cardioembolic events. CONCLUSION: Our study confirmed a relatively high prevalence of LVT in the high-risk group of patients with anterior wall STEMI. Due to the low prevalence of thromboembolic complications, no significant association between the LVT detection and the occurrence of a cardioembolic event was demonstrated.

What are the real associations of homeostasis model assessment (HOMA) with body mass index and age?

INTRODUCTION: Insulin resistance (IR), a key pathogenesis mechanism of metabolic disorders, can be tested using homeostatic model assessment (HOMA). HOMA-IR quantifies peripheral tissue IR, whereas HOMA-ß determines insulin secretion. The cross-sectional study aimed to examine non-linear associations of HOMA indices with age when adjusting for body mass index (BMI), and thus to investigate the indices' ability to reflect the real development of glucose metabolism disorders over time. MATERIAL AND METHODS: The sample comprised 3406 individuals without diabetes mellitus (DM) divided into those with normal glucose metabolism (NGT, n = 1947) and prediabetes (n = 1459) after undergoing biochemical analyses. Polynomial multiple multivariate regression was applied to objectify associations of HOMA with both age and BMI. RESULTS: Mean values of HOMA-IR and HOMA-ß in individuals with NGT were 1.5 and 82.8, respectively, while in prediabetics they were 2.2 and 74.3, respectively. The regression proved an inverse non-linear dependence of pancreatic b dysfunction, expressed by HOMA-ß, on age, but did not prove a dependence on age for HOMA-IR. Both indices were positively, statistically significantly related to BMI, with a unit increase in BMI representing an increase in HOMA-IR by 0.1 and in HOMA-ß by 3.2. CONCLUSIONS: The mean values of HOMA indices showed that, compared with NGT, prediabetes is associated with more developed IR but lower insulin secretion. Both HOMA-IR and HOMA-b are predicted by BMI, but only HOMA-ß is predicted by age. HOMA indices can reflect non-linear, closer-to-reality dependencies on age, which in many epidemiological studies are simplified to linear ones. The assessment of glucose metabolism using HOMA indices is beneficial for the primary prevention of IR and thus DM.

Molecular Hydrogen Positively Affects Physical and Respiratory Function in Acute Post-COVID-19 Patients: A New Perspective in Rehabilitation.

Molecular hydrogen (H2) is potentially a novel therapeutic gas for acute post-coronavirus disease 2019 (COVID-19) patients because it has antioxidative, anti-inflammatory, anti-apoptosis, and antifatigue properties. The aim of this study was to determine the effect of 14 days of H2 inhalation on the respiratory and physical fitness status of acute post-COVID-19 patients. This randomized, single-blind, placebo-controlled study included 26 males (44 ± 17 years) and 24 females (38 ± 12 years), who performed a 6-min walking test (6 MWT) and pulmonary function test, specifically forced vital capacity (FVC) and expiratory volume in the first second (FEV1). Symptomatic participants were recruited between 21 and 33 days after a positive polymerase chain reaction test. The experiment consisted of H2/placebo inhalation, 2 × 60 min/day for 14 days. Results showed that H2 therapy, compared with placebo, significantly increased 6 MWT distance by 64 ± 39 m, FVC by 0.19 ± 0.24 L, and, in FEV1, by 0.11 ± 0.28 L (all p ≤ 0.025). In conclusion, H2 inhalation had beneficial health effects in terms of improved physical and respiratory function in acute post-COVID-19 patients. Therefore, H2 inhalation may represent a safe, effective approach for accelerating early function restoration in post-COVID-19 patients.

Optimal Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) Cut-Offs: A Cross-Sectional Study in the Czech Population.

Background and Objectives: The key pathogenetic mechanism of glucose metabolism disorders, insulin resistance (IR), can be assessed using the Homeostasis Model Assessment of IR (HOMA-IR). However, its application in clinical practice is limited due to the absence of cut-offs. In this study, we aimed to define the cut-offs for the Czech population. Methods: After undergoing anthropometric and biochemical studies, the sample of 3539 individuals was divided into either nondiabetics, including both subjects with normal glucose tolerance (NGT, n = 1947) and prediabetics (n = 1459), or diabetics (n = 133). The optimal HOMA-IR cut-offs between subgroups were determined to maximize the sum of the sensitivity and specificity for diagnosing type 2 diabetes mellitus (T2DM) or prediabetes. The predictive accuracy was illustrated using receiver operating characteristic (ROC) curves. Logistic regression was performed to assess the association between a target variable (presence/absence of T2DM) depending on the HOMA-IR score as well as on the age and sex. Results: The HOMA-IR cut-off between nondiabetics and diabetics for both sexes together was 3.63, with a sensitivity of 0.56 and a specificity of 0.86. The area under the ROC curve was 0.73 for T2DM diagnosing in both sexes. The HOMA-IR cut-off between the NGT subjects and prediabetics was 1.82, with a sensitivity of 0.60 and a specificity of 0.66. Logistic regression showed that increased HOMA-IR is a risk factor for the presence of T2DM (odds ratio (OR) 1.2, 95% confidence interval (CI) 1.14-1.28, p < 0.0001). The predictive ability of HOMA-IR in diagnosing T2DM is statistically significantly lower in females (OR 0.66, 95% CI 0.44-0.98). The results are valid for middle-aged European adults. Conclusions: The results suggest the existence of HOMA-IR cut-offs signaling established IR. Introduction of the instrument into common clinical practice, together with the known cut-offs, may contribute to preventing T2DM.

Total and high-molecular-weight adiponectin levels and prediction of insulin resistance.

INTRODUCTION: Adiponectin is a peptide secreted by adipocytes; its reduction is associated with obesity-related disorders, including insulin resistance (IR). The study analysed levels of total adiponectin and its high-molecular-weight (HMW) oligomer in a group of metabolically healthy adults and in patients with type 2 diabetes mellitus (T2DM) to evaluate these levels as potential predictors of the presence of IR. MATERIALS AND METHODS: The study comprised 269 metabolically healthy adults and 300 patients with T2DM. Anthropometric and bio-chemical indices were measured, including total and HMW adiponectin levels; the Homeostatic Model Assessment of IR (HOMA-IR) index was calculated, and logistic regression analysis was used to predict the presence of IR. RESULTS: In healthy individuals, both total and HMW adiponectin levels were significantly higher than in diabetic patients. Total and HMW adiponectin levels were moderately correlated with the HOMA-IR index. Logistic regression analysis showed that increased levels of both total adiponectin (odds ratio [OR] 0.598, 95% confidence interval [CI] 0.483-0.723) and the HMW form (OR 0.360, 95% CI 0.242-0.511) are protective factors for the development of IR. The cut-off levels were 4.22 mg/L for total adiponectin and 2.75 mg/L for HMW adiponectin. The results are valid for middle-aged European adults. CONCLUSIONS: Adiponectin levels below the indicated cut-offs may predict a potential risk for the development of IR.

Comprehensive Group Therapy of Obesity and Its Impact on Selected Anthropometric and Postural Parameters.

OBJECTIVE: Obesity is a multifactorial disease. This non-infectious epidemic has reached pandemic proportions in the 21 century. Posture is a dynamic process referring to an active maintenance of body movement segments against the action of external forces. The aim of the study was to investigate the effect of comprehensive group therapy for obese persons on selected anthropometric and postural parameters. METHODS: The study comprised 53 females with a mean age of 44.5 years (range 29­65 years, standard deviation 9.42 years, median 44 years), who completed a controlled weight loss programme. At the beginning and at the end of the programme, anthropometric parameters (Body Mass Index (BMI), weight and waist circumference) were measured and the posturography tests Limits of Stability (LOS) and Motor Control Test (MCT) were performed using the NeuroCom's SMART EquiTest system. The data were statistically analyzed using R software at a level of significance of 0.05. RESULTS: There were positive changes after the controlled weight loss programme in anthropometric parameters (BMI reduction, with p<0.001; waist circumference reduction, with p<0.001; and weight loss, with p<0.001), postural stability with statistically significant (p<0.05) improvements in both postural activity (LOS test parameters) and reactions (MCT parameters). CONCLUSION: The study showed a statistically significant effect of comprehensive group therapy for obesity in terms of reductions in waist circumference, body weight and BMI, and thus the overall reduction of both cardiovascular and metabolic risks, as well as improved postural skills (activity and reactions).

Positive effect of yoga on cardiorespiratory fitness: A pilot study.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death in developed countries. An integral part of primary prevention is physical activity. One form of physical activity to be potentially used is yoga, but this activity is associated with lower energy expenditure than that recommended for prevention. The study aimed at assessing the effect of regular yoga sessions on the aerobic capacity of the practitioners and comparing it with the normal population performing physical activity recommended by guidelines. MATERIALS AND METHODS: Fifty-eight persons (16 males) with a mean age of 50.0 ± 11.06 years comprising the yoga group practiced yoga for at least 1 h a day for over 2 years. They underwent spiroergometry under maximal exercise testing to assess basic performance parameters. Their results were compared with those in 54 age-matched controls (16 males mean age of 48 ± 11.86 years performing a regular aerobic physical activity for at least 7 h a week. RESULTS: The yoga group had statistically significantly higher maximum performance per kilogram (P = 0.007) and maximum oxygen consumption per kilogram per minute (P = 0.028). CONCLUSIONS: Despite low energy expenditure, yoga practices are better in some cardiorespiratory fitness parameters than other aerobic activities recommended by current guidelines for CVD prevention.

Total and High Molecular Weight Adiponectin Levels and Prediction of Cardiovascular Risk in Diabetic Patients.

The study aimed at assessing the potential use of lower total and HMW adiponectin levels for predicting cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). Concentrations of total adiponectin or high molecular weight (HMW) adiponectin decrease in association with the development of metabolic dysfunction such as obesity, insulin resistance, or T2DM. Increased adiponectin levels are associated with a lower risk for coronary heart disease. A total of 551 individuals were assessed. The first group comprised metabolically healthy participants (143 females, and 126 males) and the second group were T2DM patients (164 females, and 118 males). Both total adiponectin and HMW adiponectin in diabetic patients were significantly lower when compared with the group of metabolically healthy individuals. There was a weak monotonic correlation between HMW adiponectin levels and triglycerides levels. Binary logistic regression analysis, gender adjusted, showed a higher cardiovascular risk in diabetic persons when both total adiponectin (OR = 1.700) and HMW adiponectin (OR = 2.785) levels were decreased. A decrease in total adiponectin levels as well as a decrease in its HMW adiponectin is associated with a higher cardiovascular risk in individuals with T2DM. This association suggests that adiponectin levels may be potentially used as an epidemiological marker for cardiovascular risk in diabetic patients.

[With children against obesity]. / S detmi proti obezite.

The project "With Children Against Obesity" (www.sdetmiprotiobezite.cz) is an original and innovative prevention website, which is currently unparalleled in the Czech Republic. It is a rare project that deals not only with the issue of childhood obesity for the general public but also for professionals. The website offers a comprehensive view of the prevention and treatment of overweight and obese children. The project offers original products that can be used in the everyday clinical practice for specific individuals with risks of developing obesity, including their family background. It follows the basic principles of prevention of metabolic diseases.

Effect of Physical Activity in Treatment of Paediatric Obesity.

The aim of the study was to compare the differences in anthropometric parameters, maximal oxygen uptake (VO2max) and physical activity (PA) between groups of 146 obese boys and 128 obese girls. We tried to describe the relationships between changes in PA and changes in VO2max, body fat, weight, waist circumference and hip circumference. We found statistically significant changes in VO2max and waist circumference only in the group of boys and significant changes in VO2max in the group of girls.

Evaluation of insulin resistance and metabolic syndrome in a group of obese Czech children.

OBJECTIVE: The study aimed to determine the incidence of metabolic syndrome (MS) in a group of Czech obese children, to evaluate the incidence of insulin resistance according to HOMA-IR in this group, and to consider the diagnostic value of HOMA-IR in early MS detection in obese children using the logistic regression models for analyzing the relations between HOMA IR and MS. SUBJECTS AND METHODS: Anthropometric and laboratory examinations were performed in a group of 274 obese children aged 10-17 years. RESULTS: MS was established in 102 subjects (37%). The presence of insulin resistance according to HOMA-IR >3.16 was ascertained in 53% of the subjects. HOMA-IR limit was exceeded by 70% in the MS (+) group and by 43% in children in the MS (-) (p<0.0001) category. CONCLUSION: The relatively high incidence of insulin resistance in obese children without MS questions the prevailing diagnostic criteria of, perhaps, falsely excluding some cases of, MS.

Dehiscent scar in the lower uterine segment after Caesarean section and IVF infertility treatment: a case report.

AIMS: Caesarean section is the most common obstetric operation associated with short and long term risks, one of which is uterine scar dehiscence. In this case report we describe four cases of in vitro fertilization and embryo transfer (IVF+ET) treatment where the embryo was transferred into the uterus with known scar dehiscence in the lower uterine segment after a previous Caesarean section (SC). METHODS: All transfers of embryos were ultrasound guided directly into the middle of uterine cavity. All resulting pregnancies continued without problems related to the dehiscent scar and babies were delivered in the third trimester by elective/emergency SC. RESULTS: Our cases suggest that IVF+ET can be offered as an infertility treatment option despite a dehiscent scar in the lower uterine segment after previous SC.

Acute effects of right ventricular pacing on cardiac haemodynamics and transvalvular impedance.

AIMS: To assess the acute side-effects of right ventricular (RV) stimulation applied in apex and mid-septum, in order to establish the optimal lead location in clinical practice. METHODS: During pacemaker implantation, the ventricular lead was temporarily fixed in the apex and then moved to mid-septum. In both positions, surface and endocardial electrograms and transvalvular impedance (32 cases), left ventricular (LV) pressure (23), and transthoracic echocardiography (10) were acquired with intrinsic activity and VDD pacing. RESULTS: A larger increase in QRS duration was noticed with apical than septal pacing (65±25 vs. 45±29 ms; P<10(-4)). The proportion of cases where RV stimulation affected the transvalvular impedance waveform was higher with apical lead location (56% vs. 20%; P<0.02). VDD pacing at either site reduced the maximum dP/dt by 6% with respect to intrinsic AV conduction (IAVC; P<0.005). The maximum pressure drop taking place in 100 ms was reduced by 6 and 8%, respectively, with apical and septal pacing (P<0.01 vs. IAVC). Apical VDD decreased mitral annulus velocity in early diastole (E') from 7.5±1.4 to 5.9±0.9 cm/s (P<0.02) and prolonged the E-wave deceleration time (DT) from 156±33 to 199±54 ms (P<0.02), while septal pacing induced non-significant modifications in E' and DT. CONCLUSION: Ventricular stimulation acutely impairs LV systolic and diastolic performance, independent of the pacing site. Septal lead location preserves RV contraction mechanics and reduces the electrical interventricular delay.

Central facial paresis and its impact on mimicry, psyche and quality of life in patients after stroke.

AIM: Using functional scales and face video analysis, changes in central facial paresis are monitored in patients with stroke after orofacial therapy and correlations between changes in mimicry, mental function and overall quality of life of patients after stroke are made. MATERIALS AND METHODS: A prospective randomized study of patients after stroke with facial paresis. The functional status of the experimental group of 50 cases with orofacial regulation therapy and 49 control cases without mimicry therapy is observed after four weeks of rehabilitation. RESULTS: Changes in mimicry functions evaluated by the House-Brackmann Grading System (HBGS) clinical range and using 2D video analysis of the distance between the paretic corner of the mouth and earlobe at rest and during smiling were statistically better in the experimental group than in controls. Changes in mental function - depression using Beck Depression Inventory and changes in the quality of life using Bartle index and modified Rankin score (scale) were significantly greater in the experimental group. There was a very close relationship between the changes in mimicry, mental state and overall quality of life according to the Spearman correlative coefficient. CONCLUSION: Orofacial rehabilitation therapy for patients with paresis after stroke has a significant influence on the adjustment of mimicry, mental functions and overall quality of life after 4 weeks of treatment.

Clinical anatomy aspects of functional 3D training -- case study.

INTRODUCTION: Functional 3D training originating in rehabilitation and physiotherapy routines, is modelled on the basis of a patient's functional impairment and muscle function test results. 3-D functional rehabilitation comprises two key components. The first is three-dimensional movements of the body and the second is restoration of function, The aim of 3D training is not only to improve physical fitness and muscular coordination, it is recommended for all age groups regardless of health status. The aim of this review is to highlight the main principles, roles and methods of 3D functional training from a clinically-anatomical perspective and its application in clinical practice. Second, we present a case study of 3d training in an obese boy. METHODS: Database search using the lemmatization method and data bases: Web of Knowledge, Web of Science, UpToDate, PubMed and Google Scholar for the years 2005-2011. RESULTS AND CONCLUSIONS: Functional 3D training is an effective method for, among others, strengthening the postural muscles of the human body, increasing articular stability, strengthening the ligaments and stability of muscle groups,especially the back muscles and for improving lung capacity. The method of functional training is of considerable significance in activating the pelvic floor muscles and the pelvic-trochanteric muscles for gynegymnastics and incontinence prevention. It has application in the prevention of falls in patients with neurodegenerative diseases and, as shown below, in the therapy of obesity.

Adipocyte fatty acid binding protein and C-reactive protein levels as indicators of insulin resistance development.

BACKGROUND: Adipocyte fatty acid-binding protein (aFABP) has recently been identified as a potential circulating marker for metabolic syndrome. C-reactive protein (CRP), a sensitive marker of inflammation, is increased in individuals with diabetes and metabolic syndrome due to the development of subclinical inflammation. The study uses logistic regression models to analyze the relations between aFABP and CRP along with other parameters of insulin resistance. The objective was to investigate the potential use of aFABP and CRP levels as tools in the diagnosis of the metabolic syndrome. METHODS AND RESULTS: The following groups were studied: healthy individuals (A, n=122), obese individuals (B, n=213) and patients diagnosed with metabolic syndrome (C, n=79). Obese persons in Group B had parameters suggestive of early insulin resistance: hypertension, hyperglycaemia, QUICKI (0.305) and higher aFABP levels as compared with the healthy subjects. Group C individuals were diagnosed with metabolic syndrome, as evidenced by the QUICKI markers for insulin resistance (0.293), high aFABP levels (35.3 mg/l). CRP concentrations were lowest in Group A healthy individuals (0.67 mg/l), higher in Group B obese subjects (2.65 mg/l) and highest in Group C patients with metabolic syndrome (3.62 mg/l). Logistic regression models showed an association of aFABP and CRP with BMI (OR 1.12 and 1.39, compared Group A vs C). An association of aFABP and CRP with the QUICKI index showed OR 1.48 and 1.37 (Group A vs C); with triglyceride levels showed OR 1.68 and 1.52 (Group A vs C). An association of aFABP and CRP with glycaemia showed OR 1.48 and 1.51 (Group A vs C), with insulinaemia showed OR 1.44 and 1.38 (Group A vs C) respectively. CONCLUSIONS: AFABP levels were higher in obese individuals and highest in those with metabolic syndrome. CRP concentrations were increased in obese persons whereas individuals with metabolic syndrome were found to have high-risk CRP levels. Logistic regression models showed an association of aFABP and CRP with BMI as well as an association of aFABP and CRP with parameters of insulin resistance, namely the QUICKI index, triglyceride levels, glycaemia and insulinaemia. Both methods are of diagnostic benefit for predicting metabolic syndrome, especially in previously untreated patients.

Potential markers of insulin resistance in healthy vs obese and overweight subjects.

BACKGROUND: Insulin resistance can lead to the metabolic syndrome, which may have cardiovascular and metabolic consequences. The study aimed at verifying the serum concentration levels of the adipose tissue proteins adiponectin, adipocyte-fatty acid binding protein (a-FABP) and acylation stimulating protein (ASP), and the potential use of these markers for early diagnosis of insulin resistance. METHODS AND RESULTS: Healthy subjects (Group A, n = 53), overweight subjects (Group B, n = 29) and obese subjects (Group C, n = 51) were studied. Those in Groups B and C had symptoms of insulin resistance. The subjects were selected based on clinical and laboratory findings. The concentrations of adiponectin were highest in the healthy subjects in Group A (14.18 ± 6.99 mg/), lower in the overweight subjects in Group B (11.12 ± 4.46 mg/l) and lowest in the obese subjects in Group C (8.15 ± 2.70 mg/l). The a-FABP values were lowest in Group A (20.23 ± 7.95 mg/l), higher in Group B (32.22 ± 15.56 mg/l) and highest in Group C (40.43 ± 23.31 mg/l). The concentrations of ASP were lowest in the Group A healthy subjects (43.01 ± 22.78 nmol/l), higher in the Group B overweight subjects (50.58 ± 25.57 nmol/l) and highest in the Group C obese subjects (54.70 ± 26.41 nmol/l). Statistically significant correlation coefficients in subjects from all groups among the markers studied describe the highest correlation is between a-FABP and BMI (r = 0.48), adiponectin and QUICKI (r = 0.42), adiponectin and triacylglycerols (r = -0.35), ASP and BMI (r = 0.33) and adiponectin and BMI (r = -0.31). CONCLUSIONS: The concentrations of all studied markers were different in the healthy subjects as compared to the overweight or obese ones. Adiponectin proved to be a good indicator of insulin sensitivity, the low concentration of which could signal the initial stage of insulin resistance. A-FABP proved to be a prominent marker of "adiposity" in association with the development of insulin resistance. ASP did not prove to show significant differences between the overweight and healthy subjects, but significant differences were found between the obese and healthy subject.