Beyhan Omer

Relationship Between Visceral Adipose Tissue and Adiponectin, Inflammatory Markers and Thyroid Hormones in Obese Males with Hepatosteatosis and Insulin Resistance

BACKGROUND AND AIMS In our detailed analysis of the recent academic publications, we have not found sufficient evidence regarding the changes of metabolism that occur in cases of insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the changes in various biomarkers of obese patients by taking into consideration the IR and NAFLD, which occur increasingly together. METHODS Obese male patients included in the study (n = 315) were divided into three groups. Group I was determined as mild pathology (n = 129; HOMA-IR ≥2.5 and grade 0 or HOMA-IR <2.5 and grade 1-2 hepatosteatosis), group II as moderate pathology (n = 145; HOMA-IR ≥2.5 and grade 1-2 or HOMA-IR <4 and grade 3 hepatosteatosis) and group III as severe pathology (n = 41; HOMA-IR ≥4 and grade 3 hepatosteatosis). Waist circumference (WC), percent body fat (%BF), visceral adipose tissue (VAT), subcutaneous abdominal fat tissue (SCAT), thyroid volume (Tvol), thyroid hormones, insulin, adiponectin, fibrinogen and ultrasensitive C-reactive protein (us-CRP) were measured in all patients. RESULTS A negative correlation between adiponectin and HOMA-IR was found (r = -0.4226; p <0.001). In addition, there were significant differences among all three groups with respect to VAT (p <0.01). Moreover total-triiodo-L-thyronine (TT3) and free-triiodo-L-thyronine (fT3) levels were observed first to decrease in group II compared to group I and then to increase in group III (p <0.001). Fibrinogen and us-CRP levels in group III were significantly higher (p <0.001). CONCLUSIONS TT3 and fT3 levels as well as adiponectin, fibrinogen and us-CRP levels may be affected by the relationship between IR and NAFLD in obese patients. Moreover, increased VAT is a more important risk factor than WC, %BF and BMI, with respect to IR and NAFLD.

Is there any relationship between cardiovascular risk markers and young women with diminished ovarian reserve

Abstract Objective: It has been widely known that cardiovascular disease (CVD) risk is increased in menopause. The aim of the study was to evaluate whether this risk was elevated in young women with diminished ovarian reserve (DOR). Methods: A hundred women with DOR and 100 women with normal ovarian reserve (NOR) attending the infertility unit at Suleymaniye Maternity, Research &Training Hospital, were enrolled in the study. CVD risk markers such as insulin resistance (defined by the homeostasis model assessment ratio [HOMA-IR]), C-reactive protein (CRP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) were assessed. Results: HOMA-IR, CRP, TG, LDL levels were higher and HDL was lower among patients with DOR compared to the controls (p < 0.05 for all). There were positive associations between DOR and HOMA-IR, CRP, TG, LDL levels and a negative correlation with HDL (p < 0.05 for all). However, multivariate logistic regression analysis showed that HOMA-IR, CRP, TG, and HDL were independent variables that were associated with DOR. Conclusions: CVD risk markers were increased in women with DOR. Further studies with larger groups are needed to investigate the nature of the link in these patients. Chinese abstract 目的：现在广泛认为心血管系统疾病（cardiovascular disease，CVD)）发生风险在更年期增加。本研究的目的旨在探索在伴有卵巢储备功能减退（diminished ovarian reserve，DOR）的年轻女性中其发生风险是否也会升高。方法：本试验共纳入了在苏莱曼尼耶妇产医院—研究教学医院，生殖中心就诊的100名伴有DOR以及100名卵巢储备功能正常（normal ovarian reserve ，NOR)）的女性。对CVD风险标志物例如胰岛素抵抗[主要通过稳态模式评估法计算胰岛素抵抗指数（HOMA-IR）]，C反应蛋白（CRP），低密度脂蛋白（LDL），高密度脂蛋白（HDL），总胆固醇（TC）以及甘油三酯（TG）水平进行评估。结果：DOR女性与对照组女性相比，前者HOMA-IR，CRP，TG，LDL水平较高，HDL水平较低（(p<0.05）。DOR与HOMA-IR，CRP，TG，LDL水平之间存在正相关，与HDL间存在负相关（(p<0.05）。然而，多变量逻辑回归分析指出HOMA-IR，CRP，TG,及HDL为独立变量，与DOR有关。结论：CVD风险标志物在DOR女性中升高。进一步的研究需要更大的样本量，以揭示这些患者中关联的性质。

Serum ghrelin and adiponectin levels are increased but serum leptin level is unchanged in low weight Chronic Obstructive Pulmonary Disease patients

BACKGROUND Weight loss and muscle wasting are common features reported in COPD patients and they are all related with systemic inflammation. In this study, the relationship between pulmonary functions and inflammatory and metabolic parameters in low weight COPD patients were investigated. METHODS Fifty male COPD patients were grouped according to the Global Initiative for Chronic Obstructive Lung Disease criteria. Group 1: Mild-moderate COPD patients (n=18; with a mean age of 66.4 ± 9.2 yrs; body mass index (BMI):19.7 ± 1.5 kg/m(2)), group 2: Severe-very severe COPD patients (n=32; with a mean age of 65.9 ± 10.0 yrs; BMI:19.3 ± 1.6 kg/m(2)), group 3: Control group composed of healthy nonsmoking males (n=17; with a mean age of 50.2 ± 8.4 yrs; BMI:21.85 ± 1.5 kg/m(2)). Anthropometric parameters, serum levels of adiponectin (ApN), ghrelin, leptin, hsCRP, IL-6, IL-1β, IL-8, TNF-α and pulmonary functions were compared. RESULTS Adiponectin concentration was higher in group 1 (43.3 ± 28.6 ng/mL; p<0.05) and group 2 (59.9 ± 31.8 ng/mL; p<0.001) when compared with the control group (23.5 ± 13.6 ng/mL). Ghrelin concentrations were higher in COPD groups (1281.0 ± 1173.7 and 1840.0 ± 403.6 pg/mL; p<0.05) compared to the control subjects (554.0 ± 281.9 pg/mL). When the groups were compared, no significant difference was found for leptin, IL-1β, TNF-α, and IL-8. Interleukin-6 and hsCRP levels were higher in group 1 than in the control group. ApN was negatively correlated with BMI and FEV1. In all groups, FEV1 showed positive correlation with BMI, skinfold thicknesses, insulin and triglyceride; negative correlation with age, pack/years, HDL-Chol and ApN. Increased SHBG with decreased insulin level and HOMA-IR may indicate increased insulin sensitivity in COPD groups. CONCLUSION The anti-inflammatory effect of ApN and ghrelin is more evident in severe-very severe COPD patients.

Serum level of vitamin D and trace elements in children with recurrent wheezing: a cross-sectional study

BackgroundWe aimed to show the relationship between recurrence of wheezing and serum levels of vitamin D, zinc, and copper in wheezy children compared with a healthy group.MethodsIn this cross sectional study, seventy-three children with wheezing and seventy-five controls were included without a follow-up period. The clinical characteristics of the children were assessed, the asthma predictive index and temporal pattern of wheeze were determined. The serum levels of vitamin D, zinc, and copper were measured. Pearson correlation analysis was used to evaluate the relationship between homogeneously distributed variables.ResultsThirty-two of the seventy-three children (43.8%) had more than three wheezing attacks (recurrent wheezing). The Asthma Predictive Index index was positive in 26 patients (35.6%). When classified to temporal pattern of wheeze, fifty-three of the study group (72.6%) had episodic wheezing and the remainder (27.4%) was classified as multiple-trigger wheezing. We found no overall significant difference between the study and control group in terms of vitamin D and trace elements . The vitamin D and zinc levels were significantly lower and serum copper and copper/zinc ratio was significantly higher in patients with recurrent wheezing (p =0.03, p <0.01, p =0.013, p <0.01, respectively) positive Asthma Predictive Index and multiple-trigger temporal pattern of wheeze compared with patients with non- recurrent wheezing, negative Asthma Predictive Index and episodic temporal pattern of wheeze.ConclusionIt may be postulated that for the determination of asthma risk in patients with recurrent wheezing, the serum level of vitamin D, copper and zinc can be used as a routine biomarker alongside the Asthma Predictive Index and temporal pattern of wheeze.

Leptin concentration indexed to fat mass is increased in untreated anorexia nervosa (AN) patients

Context  Data regarding serum adipocytokine and ghrelin concentrations in different stages of anorexia nervosa (AN) is conflicting.

Evaluation of turbidimetric inhibition immunoassay (TINIA) and HPLC methods for glycated haemoglobin determination.

Various factors may affect the accuracy of hemoglobin (Hb) A1c measurements that are widely used to monitor glycemic control in diabetic patients. This study was aimed to compare the values of HbA1c obtained by two different methods, Roche Tina‐quant second and thirdgeneration HbA1c assays based on the turbidimetric inhibition immunoassay (TINIA), and high‐performance liquid chromatography (HPLC) cation‐exchange method used by Arkray Adams HA‐8160 analyzer.

Role of vitamin D in children with hepatosteatosis.

Background: The increasing incidence of obesity in children is a significant risk factor for nonalcoholic fatty liver disease and obesity-associated morbidity. Vitamin D has a major role in bone mineral metabolism and has antimicrobial, antioxidant properties. In this study we aimed to investigate the role of vitamin D in children with obesity with hepatosteatosis. Methods: A total of 101 children with obesity were included in this study. Hepatosteatosis was diagnosed and graded using ultrasonography. Serum levels of 25-hydroxyvitamin D (25-(OH) vitamin D), calcium, phosphate, alkaline phosphatase, and parathormone were tested. Two-sided t test and Pearson &khgr;2 tests were used for the relation between vitamin D and hepatosteatosis. Results: In our study group, 45.5% were girls (n = 46) and the mean age was 11.5 ± 2.8 years (range 3–17 years). Hepatosteatosis was identified in 58 children (57.4%). The diagnosis of grade 1 and grade 2 hepatosteatosis was made in 41 (40.6%) and 17 (16.8%) children, respectively. Median serum 25-(OH) vitamin D levels in children without hepatosteatosis was 16.4 ng/mL (interquartile range 12.4–24.8 ng/mL), whereas children with grade 1 and grade 2 hepatosteatosis had 25-(OH) vitamin D levels of 14.2 ng/mL (interquartile range 9.5–21.2 ng/mL) and 11.5 ng/mL (interquartile range 7.5–16.7 ng/mL), respectively (P = 0.005). There was a positive correlation between insulin resistance and the grade of hepatosteatosis (P = 0.03). Conclusions: Serum vitamin D levels in children with obesity with hepatosteatosis are significantly lower than vitamin D levels in children with obesity without hepatosteatosis. In this observational study we only refer to the association of vitamin D deficiency/insufficiency with hepatosteatosis.

Low concentrations of adropin are associated with endothelial dysfunction as assessed by flow-mediated dilatation in patients with metabolic syndrome.

Abstract Background: In individuals with atherosclerotic risk factors, endothelial dysfunction (ED) appears as an early phase in the development of clinical symptoms. Recent studies indicate that adropin, a newly identified peptide, participates in cardiovascular health through the regulation of several metabolic events including angiogenesis and blood flow. In this study, we aimed to determine the relation of adropin with biochemical and radiologic parameters which reflect ED such as endothelial nitric oxide synthase (eNOS), endothelin 1 (ET-1), nitric oxide (NO) and flow-mediated dilatation (FMD) along with the routine biochemical measurements in patients recently diagnosed with metabolic syndrome (MetS). Methods: Fasting blood samples from 110 patients with MetS diagnosed according to the NCEP ATP III-2005 criteria were collected to measure the concentrations of adropin and other parameters including the lipid profile, insulin and glucose. Serum NOx concentrations were determined by measuring NO2 plus NO3. FMD test was performed by ultrasonography, and patients were stratified as FMD (+) or (–). Data were compared between these two subgroups and also with matching healthy controls (n=50). Biochemical data were evaluated using Student’s t or Mann-Whitney U tests. Results: Fifty-nine subjects had ED (+) and the remaining 101 subjects were ED (–). In the first group, adropin levels were significantly lower than the latter (2.13±1.05 vs. 3.41±1.63 ng/mL, respectively; p<0.001) and independently associated with FMD positivity as assessed by the logistic regression analysis. Conclusions: Low adropin level in circulation is related to ED and has a close association with FMD. Any alterations in its level may be of help in order to assess the development of ED before the occurrence of clinical symptoms in patients with metabolic syndrome.

Hypovitaminosis D is Associated with Endothelial Dysfunction in Patients with Metabolic Syndrome

OBJECTIVES Recent research has shown that hypovitaminosis D may increase the risk of hypertension, vascular disease, diabetes mellitus, obesity and Metabolic Syndrome (MetS). Endothelial Dysfunction (ED) is one of the key components of MetS which is associated with an imbalance between vasoactive substances such as Nitric Oxide (NO) and Endothelins (ET). In this study, we assessed the association of 25(OH) D3 level with endothelial dysfunction and subclinical atherosclerosis in MetS patients. DESIGN AND METHODS 105 MetS patients and 48 controls were included. 25(OH) D3 levels were measured using Ultra-High Performance Liquid Chromatography (UHPLC). NOx (NO2 plus NO3) and Endothelin- 1(ET-1) concentrations were determined along with routine biochemical tests. Flow-Mediated Dilatation (FMD) and carotid Intima-Media Thickness (cIMT) were measured by ultrasonography. RESULTS In MetS patients, vitamin D and NOx levels were significantly lower (p<0.001), while ET-1 levels were higher than controls (p<0.005). MetS patients with ED exhibited significantly lower vitamin D levels than their counterparts free of ED. Vitamin D levels were correlated positively with FMD and NOx, and negatively with systolic blood pressure and body mass index. Subclinical atherosclerosis as assessed by the cIMT did not associate with low vitamin D levels. CONCLUSION Vitamin D deficiency seen in MetS patients is more prominent in the presence of ED. Hypovitaminosis D may affect endothelial cells, and participate in the development of hypertension.

A Comparison of hs-CRP Levels in New Diabetes Groups Diagnosed Based on FPG, 2-hPG, or HbA1c Criteria

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) have been used to diagnose new-onset diabetes mellitus (DM) in order to simplify the diagnostic tests compared with the 2-hour oral glucose tolerance test (OGTT; 2-hPG). We aimed to identify optimal cut-off points of high sensitive C-reactive protein (hs-CRP) in new-onset DM people based on FPG, 2-hPG, or HbA1c methods. Data derived from recent population-based survey in Turkey (TURDEP-II). The study included 26,499 adult people (63% women, response rate 85%). The mean serum concentration of hs-CRP in women was higher than in men (p < 0.001). The people with new-onset DM based on HbA1c had higher mean hs-CRP level than FPG based and 2-hPG based DM cases. In HbA1c, 2-hPG, and FPG based new-onset DM people, cut-off levels of hs-CRP in women were 2.9, 2.1, and 2.5 mg/L [27.5, 19.7, and 23.5 nmol/L] and corresponding values in men were 2.0, 1.8, and 1.8 mg/L (19.0, 16.9, and 16.9 nmol/L), respectively (sensitivity 60–65% and specificity 54–64%). Our results revealed that hs-CRP may not further strengthen the diagnosis of new-onset DM. Nevertheless, the highest hs-CRP level observed in new-onset DM people diagnosed with HbA1c criterion supports the general assumption that this method might recognize people in more advanced diabetic stage compared with other diagnostic methods.