Armin Rashidi

Metabolic Syndrome and Insulin Resistance Significantly Correlate with Body Mass Index

BACKGROUND Metabolic syndrome (MetS) is a cluster of metabolic risk factors for cardiovascular disease. This study aimed to compare the prevalence of MetS and its components in different degrees of obesity in Iranian subjects. METHODS A total of 2309 adults were divided into four groups according to their body mass index (BMI): 1511 subjects were non-obese (BMI <30 kg/m(2)); 535 were moderately obese (BMI > or =30-<35); 176 were severely obese (BMI > or =35-<40) and 87 were morbidly obese (BMI > or =40). Fasting blood samples were obtained and plasma glucose, lipids, insulin and HbA1c were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The prevalence of MetS, according to the definitions of the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (ATPIII), was compared across increasing grades of BMI. RESULTS Prevalence of MetS gradually rose with increasing grades of obesity (p<0.001), from 31.9% in the non-obese to 69.0% in the morbidly obese according to the IDF criteria and from 31.2% to 62.1% according to the ATPIII criteria. After controlling for age and sex, one grade increase in the BMI category was associated with 2.5-3 times higher risk of MetS depending on the definition used. In addition, HOMA-IR was significantly correlated with BMI in all subjects (r=0.343, p<0.001) and in moderately (r=0.184, p<0.01), severely (r=0.147, p<0.01) and morbidly (r=0.101, p<0.05) obese participants separately. CONCLUSIONS MetS and its components, including high blood pressure, central obesity, hyperglycemia, IR, hypertriglyceridemia and low high-density lipoprotein-cholesterol increase in parallel with increasing obesity grades.

Optimal waist circumference cut-offs for the diagnosis of metabolic syndrome in Iranian adults: results of the third national survey of risk factors of non-communicable diseases (SuRFNCD-2007).

1 Boulton AJ, Angus E, Ayyar DR, Weiss DR. Diabetic thoracic polyradiculopathy presenting as abdominal swelling. Br Med J (Clin Res Ed) 1984; 289: 798–799. 2 Oyibo SO, Prasad YD, Jackson NJ, Jude EB, Boulton AJ. The relationship between blood glucose excursions and painful diabetic peripheral neuropathy: a pilot study. Diabet Med 2002; 19: 870– 873. 3 Tesfaye S, Malik R, Harris N, Jakubowski JJ, Mody C, Rennie IG et al. Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis). Diabetologia 1996; 39: 329–335.

HbA1c negatively correlates with LCAT activity in type 2 diabetes

AIMS Abnormal high-density lipoproteins (HDL) metabolism is a major cardiovascular risk factor in type 2 diabetes mellitus (DM2). Lecithin:cholesterol acyltransferase (LCAT) increases HDL size by transferring 2-acyl groups from lecithin or phosphatidylethanolamine to unesterified cholesterol. The purpose of this study was to determine the independent correlates of LCAT activity in DM2 patients. METHODS A total of 45 (male: 20) consecutive adult DM2 patients aging 50.0+/-7.0 years (range: 40-64 years) with a median diabetes duration of 4 years (range: 2-18) were studied. Exclusion criteria were: smoking, positive history of cardiovascular, thyroid, renal or liver disease, pregnancy, treatment with metformin, insulin, lipid lowering drugs, angiotensin-converting enzyme inhibitors, aspirin or antioxidant supplements. Univariate and multivariate analyses were performed. RESULTS From a comprehensive list of variables studied, only HbA1c (rho=-0.951) and oxidized LDL (rho=-0.779) had statistically significant correlation with LCAT activity (p<0.001). These two variables were themselves strongly correlated to each other (rho=0.809, p<0.001). To eliminate potential confounding effects, we performed multivariate analysis, where HbA1c emerged as a strong independent predictor of LCAT activity (adjusted OR=-0.928, p<0.001). CONCLUSIONS Glycemia-induced glycation of HDL decreases LCAT activity. The fact that HbA1c is an accurate measure of glycation and can therefore reflect glycated HDL levels explains the association found in the present study. In conclusion, HbA1c provides an easy-to-assess, accurate measure of LCAT activity in DM2.

Pyloric injection of botulinum toxin for the treatment of refractory GERD accompanied with gastroparesis: a preliminary report.

Gastroesophageal reflux disease (GERD) refractory to conventional medical treatment is frequently associated with gastroparesis, a complex condition with no definitive treatment to date. We first developed a scoring system to assess the severity and frequency of both reflux- and gastroparesis-related symptoms. We then tested, for the first time, the hypothesis that endoscopic pyloric botulinum toxin injection alleviates both of these symptom types. Eleven patients (four males) with GERD (confirmed by esophageal pH monitoring) plus gastroparesis (confirmed by gastric emptying study) underwent toxin injection. Patients had no concomitant disease and were not allowed to use prokinetics before or after treatment. Injection significantly improved both gastroparesis- and reflux-related symptoms in the majority of patients but the duration of symptom relief was relatively short. Responders to treatment had significantly higher total reflux symptom scores (before injection) than nonresponders. All but one of the patients in whom gastroparesis symptoms improved also showed response in reflux symptoms, which supports our hypothesis. We believe that response to toxin injection is a reliable predictor of response to subsequent surgery following the recurrence of symptoms.

The insertion/deletion polymorphism of the angiotensin-converting enzyme gene is associated with progression, but not development, of albuminuria in Iranian patients with type 2 diabetes

Introduction. The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene has been shown to be associated with a number of complications of type 2 diabetes. Results on the development and progression of albuminuria, however, have remained controversial, with ethnic differences being a potential reason.The present study is the first report to examine Iranian patients. Methods. Patients (322; 162 males) with type 2 diabetes were categorised in this cross-sectional study into the following groups: normoalbuminuria (n=145), microalbuminuria (n=129) and macroalbuminuria (n=48).ACE gen I/D polymorphism genotypes were determined using the polymerase chain reaction method. Results. The distribution of ACE genotypes was significantly different among the groups (p<0.001), with the II genotype decreasing and the DD genotype increasing in frequency with increasing severity of albuminuria. Multivariate regression analysis showed that the ACE genotype did not change the odds of having microalbuminuria versus normoalbuminuria, while the D allele independently increased the odds of having macroalbuminuria versus microalbuminuria approximately threefold (p<0.01). Conclusions. In Iranian patients with type 2 diabetes, the D allele is associated with progression, but not development, of albuminuria.

The relationship between angiotensin-converting enzyme insertion/deletion polymorphism and proliferative retinopathy in type 2 diabetes

A total of 136 type 2 diabetic patients with nonproliferative and 94 patients with proliferative diabetic retinopathy (PDR) without nephropathy were studied. The DD genotype of the angiotensin-converting enzyme polymorphism was more common in the PDR group (P<0.001). In multivariate regression, the association remained significant (OR=3.516).

The relationship between ACE gene insertion/deletion polymorphism and diabetic retinopathy in Iranian patients with type 2 diabetes.

Background: The role of genetic factors in diabetic retinopathy (DR) is unclear. We investigated the relationship between DR and an insertion/deletion polymorphism in the angiotensin-converting enzyme (ACE) gene in Iranian patients with type 2 diabetes without overt nephropathy. Methods: A total of 178 consecutive type 2 diabetic patients with DR (Group A) and 206 type 2 diabetic patients without DR (Group B) were studied. The following variables were determined: age, sex, body mass index, diabetes duration, medications used, history of coronary artery disease and its complications, blood pressure (systolic and diastolic), fasting plasma glucose, hemoglobin A1c, total cholesterol, low- and high-density lipoproteins, triglycerides, plasma creatinine, and 24-h urine albumin excretion. Results: The groups were statistically similar in all variables except diabetes duration (P = 0.037), ACE activity (P < 0.001), and ACE genotype (P = 0.008). The DD genotype was significantly more common in Group A (32.6% versus 19.2% in Group B; P = 0.009). In multivariate regression analysis, the ID genotype (compared to the II genotype) was an independent predictor of DR (OR = 1.831, 95% CI = 1.074–3.124; P = 0.026). Conclusions: The D allele of the ACE gene is independently associated with DR in Iranian type 2 diabetic patients.

Low frequency of blood group A in primary central nervous system lymphoma

ABO blood groups have been associated with a number of cancers, most prominently gastric cancer [1]. We and other groups demonstrated an association between blood groups and myeloid malignancies [2–5]. However, there is very little literature on such associations with lymphoma. The only available study was conducted on 63 patients with Hodgkin’s lymphoma and 78 patients with non-Hodgkin’s lymphoma; it revealed a significantly lower prevalence of blood group A among both groups compared with healthy controls [5]. Primary central nervous system lymphoma (PCNSL) is a high-grade non-Hodgkin’s B-cell neoplasm that typically remains confined to the CNS. It accounts for approximately 3% of all primary brain tumors. Immunodeficiency and Epstein–Barr virus infection are risk factors identified for PCNSL [6]. We opted to assess, for the first time, the association between ABO blood groups and PCNSL. We had 36 patients (24 males) aged 47.9 ± 13.3 years (range 18–73) with an established diagnosis of PCNSL, in three referral hospitals in Tehran. The diagnoses had been made on the basis of appropriate combinations of neuroimaging, histopathology, immunohistochemistry, and examination of cerebrospinal fluid and vitreous samples, as reviewed elsewhere [6]. The distribution of ABO blood groups among patients was compared with data previously published for 1,000 Iranian healthy controls [7]. For subset analysis, a Bonferroni’s correction was applied by multiplying P values by 4. The O:A:B:AB ratio among patients and controls were 20 (55.6%):3 (8.3%):10 (27.8%):3 (8.3%) and 356 (35.6%):371 (37.1%):212 (21.2%):61 (6.1%), respectively (P = 0.005). Group O was significantly more common among patients (P = 0.018), but the significance disappeared after Bonferroni’s correction. However, we found a dramatically lower frequency of group A among patients (P = 0.0008), which remained significant after correction. Although it is the most common blood group in Iran, group A was found in only 8.3% of our patients. To the best of our knowledge this is the first study to evaluate the association between blood groups and PCNSL. Our results support the previous finding that the frequency of blood group A is lower than normal in lymphoma patients. The mechanism of this relationship is currently unclear to the authors. It could possibly be mere association with no direct causal effect, i.e. blood group A being associated with a lower frequency of potential genes that promote PCNSL. Whatever the mechanism, blood group A seems to be a visible sign of relative protection against lymphoma and, in particular, PCNSL.

Reply: “Treatment-of-choice for Buerger’s disease (thromboangiitis obliterans): still an unresolved issue”

Dear Editor, We thank Dr Paraskevas for his careful attention to our paper [1, 2]. The statement in the Abstract that all patients were smokers was incorrect. Indeed, and as reported in the main text, 1% of our patients were not smokers. Regarding the second comment, the two patients for whom the treatment modality was not mentioned had refused treatment. Regarding the third comment, we have recently started to use novel therapeutic strategies, as mentioned by the author [2]. However, our sample size has not yet become large enough to report the results. Dr Paraskevas also asked for the outcome of the therapeutic management of our patients. Sympathectomy led to significant improvements in ulcers, pain at rest and paresthesia in 61%, 61% and 53% of patients, respectively. Bypass graft surgery significantly improved ulcers, paresthesia, foot claudication and calf claudication in 83%, 83%, 81% and 75% of patients, respectively.