Do components of metabolic syndrome contribute to cardiac autonomic neuropathy in non-diabetic patients?

OBJECTIVE: To evaluate whether autonomic dysfunction exist in patients with metabolic syndrome (MetS) to establish any association with components of MetS. METHODS: From July 2008 to January 2009, 32 outpatients attending the University Clinical Center, Zemun, Belgrade, Serbia, 15 with MetS, 17 with type 2 diabetes mellitus (T2DM), and 15 control subjects were recruited for cross-sectional study among adults. The study was completed at the University Clinical Center, Bezanijska Kosa, and University Clinical Center, Dragisa Misovic, Belgrade, Serbia. Inclusion criteria were the presence of MetS without T2DM, T2DM and healthy controls, matched for age and gender. Exclusion criteria were uncontrolled diabetes (glycosylated hemoglobin [HbA1c] higher than 9%), advanced complications of diabetes (retinopathy, nephropathy, coronary heart disease, or peripheral angiopathy). Besides anthropometric and metabolic parameters cardiovascular autonomic reflex tests, ambulatory ECG monitoring, and blood pressure monitoring for 24 hours was obtained. Power spectral analysis of heart rate variability (HRV) was carried out by Fourier transformation. RESULTS: Mean total power (TP) log-transformed (ln), very low frequency (VLF)ln power, and high frequency (HF)ln power were significantly lower in T2DM patients, when compared with controls, and only HFln power was significantly lower in the MetS group. The average value of low frequency (LF)/HFln ratio was significantly higher in T2DM and MetS, and significantly correlated with glucose level of the last one. CONCLUSION: Disturbed HRV indices were present in patients with MetS before the development of T2DM. With this in mind, improvement of glucose metabolism, as well as early detection of cardiac autonomic dysfunction should be important.

Effect of n-3 fatty acids on nutritional status and inflammatory markers in haemodialysis patients.

AIMS: Nutrition as an aetiological factor participates a great deal in premature atherosclerosis in haemodialysis (HD) patients. The basic mechanisms of end-stage renal disease and premature atherosclerosis are connected with changes in cell functions at the membrane level. We investigated the red cell membrane fatty acids and the effects of fish oil supplements on nutritional status and inflammatory markers in HD patients. METHODS: We examined 42 HD patients (mean age 55 +/- 8 years). The control group consisted of 16 healthy subjects of similar age and sex to the tested group. HD patients were administered supplements with 2.4 g of n-3 polyunsaturated fatty acids per day for 2 months. Before and after supplementation, we examined plasma lipids, cell membrane erythrocyte phospholipids content, serum albumin, haemoglobin, interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha). RESULTS: Baseline values in the tested group confirmed the presence of essential fatty acids deficiency. A statistically significant negative correlation between TNF-alpha and eicosapentaenoic acid (EPA) (r = -0.497; P < 0.05) and IL-6 and EPA (r = -468; P = 0.03) was found in HD patients before supplementation. There was a significant increase in docosahexaenoic acids, high density lipoprotein cholesterol, plasma albumin, haemoglobin levels in HD patients after supplementation (P = 0.0001). There was a significant increase in EPA (P = 0.01) after treatment, and there was a significant decrease in inflammatory markers (IL-6 and TNF-alpha, P = 0.0001) after supplementation in the tested group. CONCLUSION: A dietary regime with fish oil could be used in dialysis patients to slow down the development of atherosclerosis and improve nutritional parameters.

[Inflammatory markers, nutritional parameters and polyunsaturated fatty acids in hemodialysis patients].

INTRODUCTION: Malnutrition and inflammation are associated with end-stage renal disease. Inflammation leads to reduced synthesis of albumin, transferin, and other negative acute-phase proteins and increases their catabolic rates. The causes of inflammation are multifactorial, including oxidative modification of plasma proteins, interaction of blood with nonbiocompatible membranes, and other infectious processes. Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) powerfully predict death from cardiovascular disease in dialysis patients as well as progression of vascular injury. The aim of our study was to establish a correlation between markers of inflammation and parameters of malnutrition in hemodialysis patients. MATERIAL AND METHODS: We examined 42 hemodialysis patients at the mean age of 55+/-8 with dialysis duration 52.6+/-42. For nutritional assessment subjective global assessment (SGA), anthropometric parameters, bio-electric impedance (BIA), and biochemical nutritional parameters were used. We measured their plasma levels of inflammatory markers: C-reactive protein, IL-6 and TNF-alpha. Patients with severe malnutrition had higher level of IL-6 and TNF-alpha. RESULTS AND DISCUSSION: The following correlations between measured parameters emerged. There was a negative correlations between serum albumin concentration and inflammatory markers (r=-0.31; p=0.05). Anthropometric parameters in hemodialysis patients were lower when inflammatory markers were higher and correlation was significant (p=0.05). A statistically significant negative correlation between TNF-alpha and EPA (r=-0.497; p<0.05) and IL-6 and EPA (r=-468; p=0.03) was found in hemodialysis patients. CONCLUSION: The main findings of this study were that the decrease of nutritional parameters in hemodialysis patients were related to the degree of inflammation. Nutritional factors, as essential fatty acids, could lead to permanent changes in the inflammatory process.