Emilia Rusu

Metabolic effects of low glycaemic index diets.

The persistence of an epidemic of obesity and type 2 diabetes suggests that new nutritional strategies are needed if the epidemic is to be overcome. A promising nutritional approach suggested by this thematic review is metabolic effect of low glycaemic-index diet.The currently available scientific literature shows that low glycaemic-index diets acutely induce a number of favorable effects, such as a rapid weight loss, decrease of fasting glucose and insulin levels, reduction of circulating triglyceride levels and improvement of blood pressure.The long-term effect of the combination of these changes is at present not known.Based on associations between these metabolic parameters and risk of cardiovascular disease, further controlled studies on low-GI diet and metabolic disease are needed.

Effects of lifestyle changes including specific dietary intervention and physical activity in the management of patients with chronic hepatitis C--a randomized trial.

BackgroundIn patients with chronic hepatitis C (CHC), obesity is involved in the pathogenesis of insulin resistance, fatty liver disease and progression of fibrosis. The objective of this study was to compare a normoglucidic low-calorie diet (NGLCD) with a low-fat diet (LFD) among participants with CHC. Aimed to measure the impact of dietary changes in reduction of insulin resistance, obesity but also in steatosis and fibrosis.MethodsRandomized, controlled trial in three medical centers with assessments at baseline, 6 months and 12 months. Participants were patients over 35 years with chronic hepatitis C (n = 120) with BMI over 25 kg/m2. We evaluated the effects of NGLCD vs. LFD in weight management and metabolic improvement. The primary endpoint was to measure the impact of dietary changes through nutritional intervention in reversibility of insulin resistance, obesity, steatosis, and fibrosis. We performed anthropometric measurements, fasting glucose profile, serum lipids, liver profile, blood count at baseline, 6 and 12 months. Steatosis was evaluated using ultrasonographic criteria. Liver fibrosis was non-invasively assessed.ResultsAfter 6 and 12 months of intervention, both groups had a significant decrease in caloric consumption. At 6 months, weight loss was greater in the NGLCD group (−5.02 ± 3.43 kg vs. −4.1 ± 2.6 kg; p = 0.002) compared to the LFD group. At 1-year, however, weight loss was similar in both groups (−3.9 ± 3.3 kg vs. −3.1 ± 2.6 kg; p = 0.139). At 12 months, fasting plasma glucose, fasting plasma insulin, and HOMA-IR had significant improvements in both groups. With both diets aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT) decreased with significant differences; also there were significant improvements in AST/ALT ratio, Forns fibrosis index. The two diets were associated with reduction of both the prevalence and the severity of steatosis (all p < 0.001). At 12 months, total cholesterol, HDL-cholesterol, triglycerides improved in both groups (all p < 0.05).ConclusionsThe present study establishes the benefits of low-calorie diet and low-fat diet in management of patients with hepatitis C regarding improvement of insulin resistance, steatosis and also fibrosis.Overweight or obese patients with CHC undergoing a lifestyle intervention (specific dietary intervention and physical activity) for 1-year had significant improvements in body weight, lipid and hepatic profile.Trial registrationPNCI2-3343/41008/2007

The Association Between Insulin Resistance And Advanced Renal Disease In Type 1 Diabetes

Abstract Background and Aims. Insulin resistance is documented in type 1 diabetes and it has been associated with chronic complications. Diabetic nephropathy is a major cause of morbidity and mortality. The purpose of this article is to quantify insulin resistance in type 1 diabetes subjects according to the presence or absence of advanced renal disease. A secondary objective was to study the possible association between insulin resistance and advanced renal disease. Material and Methods. This was a cross-sectional study that included 167 type 1 diabetes patients. Insulin resistance was determined using the eGDR (estimated glucose disposal rate) formula. The association between eGDR and diabetic nephropathy was assessed in uni and multivariate models using stepwise logistic regression analysis of variables. The contribution of individual predictors in the final regression model was examined using Wald statistic. Results. Significantly lower eGDR’s values were observed in patients with nephropathy: 5 vs. 7.3 (p<0.001). In univariate analysis eGDR was significantly associated with diabetic nephropathy (p<0.001). eGDR variable was retained in the final model of stepwise logistic regression (p<0.001) and showed the strongest association with diabetic nephropathy (Wald = 30.4). Conclusions. In type 1 diabetes patients insulin resistance was the most important independent risk factor associated with advanced renal disease.

Relationship between Fasting Insulin Concentration as a Risk Factor for Cardiovascular Disease and High-Density Lipoprotein Cholesterol Levels in Patients with Chronic Hepatitis C

The objective of this study was to evaluate the association between fasting insulin concentration—as a cardiovascular risk factor—and the high density lipoprotein level (HDL-c) in patients with chronic hepatitis C. Material and Methods: In this cross-sectional study, were included 171 patients from Bucharest, to which were followed anthropometric indexes. Biochemical parameters followed were glucose fasting insulin, glycosylated hemoglobin, lipid profile, liver profile, blood counts. The 10-year coronary heart disease (CHD) was calculated for each patient using the UKPDS risk engine. Results: The mean age of patients was evaluated 53.14 ± 8.3 years, females representing 53.8% (n=92) of total. Using the UKPDS score 24% (n=41) and 20.5% (n=44) presented moderate and high risk of cardiovascular disease. Levels of fasting insulinemia was significantly high in patients with increase (12.2 uUI/ml) and moderate risk (16.4 uUI/ml) of cardiovascular disease (p Conclusions: A higher fasting insulin concentration or hyperinsulinemia was significantly associated with an increased cardiovascular risk. This study suggests that early fasting insulin ascertainment in the patients with HCV may help clinicians identify those who are potentially at high risk of CVD. Disclosure R. Dragut: None. E. Rusu: None. R. Cursaru: None. F. Rusu: None. A. Cursaru: None. H. Popescu: None. G. Radulian: None.

HEALTH RELATED QUALITY OF LIFE OF PATIENTS WITH DIABETES IN ROMANIA

Abstract Background and aims: This paper aims at understanding patient’s perspective in coping with diabetes in Romania. The study analyzes whether there are significant differences between health related quality of life (HRQL) of patients with diabetes, based on socio-demographic and disease-related characteristics. Material and methods: The study included 128 patients aged ≥ 18 years, diagnosed with type 1 and 2 diabetes and was conducted in the period of November 2015 – July 2016. The project included two main research instruments – one questionnaire applied face-to-face to each patient and one questionnaire completed by the physicians including health data for each patient who agreed to participate in the study. The set of tested characteristics includes: (i) gender; (ii) place of residence; (iii) education level; (iv) marital status; (v) employment status; (vi) level of personal income; (vii) age; (viii) type of diabetes; (ix) duration of diabetes; (x) household composition (another person with diabetes); (xi) network support and (xii) patient’s access to information and communication technology (ICT). Results: The mean age was 54.23±12.76 years, with three quarters of respondents above the age of 40 years and 68% married. More than half of participants have access to internet, either at home or at work. Conclusions: The results indicate that gender, household’s composition, place of residence, access to ICT, employment status, type of diabetes, personal income level, the presence of a support network, age and diabetes duration differentiate between reported HRQL indicators. The study adds knowledge for understanding chronic disease patients’ self-assessment of HRQL in Romania.

Metabolic Disorders in Patients with HIV

Abstract Human Immunodeficiency Virus (HIV) infection and subsequent antiretroviral therapy (ART) are known to be related to different metabolic disorders. Although ART decreased HIV-associated mortality and morbidity, mortality rates in patients with HIV and ART are 3 to 15 higher than those in the general population. More than 50% of the mortality is due to diseases like: diabetes mellitus (DM), hypertension, cardiovascular diseases (CVD), chronic renal disease and complications following bone fractures. In patients with HIV the metabolic disorders are mainly caused by mithocondrial toxicity, a side effect of ART, and they are represented by: dyslipidemia, lipoatrophy, insulin resistance and diabetes mellitus.

Liver and Metabolic Diseases

Abstract Chronic liver diseases and metabolic disorders represent two real public health problems that cause increased morbidity and mortality in a significant number of people worldwide. The most common cause of chronic liver disease is represented by non-alcoholic fatty liver disease (NAFLD). Hepatic inflammation is a critical event in the progression of NAFLD and excess adiposity, through the hormones and cytokines secreted by the adipose tissue, plays an important role. There is ample evidence supporting a significant association between chronic hepatitis C (CHC) and metabolic disorders. CHC may be considered not just a viral disease, but also a metabolic type condition. Multiple pathogenic mechanisms have been proposed to explain the interaction between hepatitis C virus and impairment of glucose and lipid metabolism and diabetes. The relationship between hepatitis B infection (HBV) and metabolic diseases remains uncertain.

Prevalence of Obesity and Newly Diagnosed Diabetes in the Roma Population from a County in the South Part of Romania (Călăraşi County) -Preliminary Results

Abstract Background and Aims: This study’s aim was to evaluate the prevalence of obesity and new cases of diabetes in Roma population compared to ethnic Romanian Caucasians from Călăraşi County in the south part of Romania. Material and Methods: The population included in this study is part of a larger project that aims to evaluate the prevalence of obesity, prediabetes and diabetes in the Roma population from Călăraşi County. So far we have included 344 people: 180 Roma (119 female/61 male), and 164 non-Roma (108 female/56 male) aged between 18 and 85. Results: In Roma population, the prevalence of underweight, normal weight, overweight and obesity was 4.4% (n=8), 37.2% (n=67), 26.7% (n=48) and 31.7% (n=57) respectively. In Romanian Caucasians, the prevalence of overweight and obesity was 37.2% (n=61) and 32.3% (n=53) respectively. Diabetes was diagnosed in 14.6% (n=24) of Romanian Caucasians and in 11.7% (n=21) of Roma population. Risk factors for obesity in Roma population were: lower socio-educational level, smoking, physical inactivity (active less than 30 min/day). Conclusions: High prevalence of overweight (26.7%), obesity (31.7%) and new cases of diabetes (11.7%) among the Roma population in the south part of Romania, Calarasi County was an important finding of our study. We observed a negative effect of lifestyle behaviours on health-related outcomes: smoking, sedentariness, lower socio-educational level.

Markers of Bone Turnover and 25-Hydroxy Vitamin D in Women with Type 2 Diabetes and Newly Diagnosed Osteoporosis

Abstract Background and Aims: The aim of the present study was to evaluate the characteristics of bone turnover markers and 25-hydroxy vitamin D levels in women with type 2 diabetes and recently diagnosed postmenopausal osteoporosis. Material and Methods: We performed a retrospective study that included 80 women with newly diagnosed postmenopausal osteoporosis: 40 women with type 2 diabetes (diabetic group) and 40 women without diabetes (non-diabetic group). For data collection we used the patients database of the National Institute of Endocrinology ”C.I. Parhon”, Bucharest, Romania. Results: Women with type 2 diabetes had significantly reduced levels of osteocalcin and crosslaps than non-diabetic women. In the diabetic group, alkaline phosphatase and 25-hydroxy vitamin D were lower than in non-diabetic women but without statistical significance. There was not statistically significant difference of bone mineral density (BMD) between diabetic and non-diabetic groups. Magnesium was significantly lower in diabetic women compared with non-diabetic women. Conclusions: Our results demonstrated a low bone turnover in type 2 diabetic women and it was shown an insufficiency of 25-hydroxy vitamin D in both studied groups. These findings should be taken into account when screening these patients for diabetes complications.

Study On The Prevalence Of Various Forms Of Cancer In Diabetic Patients Hospitalized In The National Institute Of Diabetes, Nutrition And Metabolic Diseases “Prof. N.C. Paulescu”

Abstract Background and aims: Epidemiological evidence suggests that people with diabetes have a significantly increased risk of developing various cancers. The aim of the study was to assess the frequency of various cancers in diabetic patients admitted in the National Institute of Diabetes Nutrition and Metabolic Diseases “Prof. N.C. Paulescu” between 01.01.2011 and 01.09.2014. Material and methods: The study analyzed a total of 24.104 admissions, corresponding to a total of 13.960 patients. A total of 520 hospitalizations with a diagnosis of cancer and diabetes were indentified. Finally, 298 patients meeting the inclusion and exclusion criteria were included in the study. For these patients, personal history, clinical and laboratory data were assessed. Results: The prevalence of cancer in hospitalized diabetic patients was 2.13%. The most frequent types of cancer (number of cases) were: breast - 63 patients, colorectal - 45 patients, pancreatic - 37 patients, lung - 31 patients and prostate - 20 patients. Conclusions: Our data showed that the most common form of cancer associated with diabetes was breast cancer (21%), followed by colorectal cancer (15.10%) and pancreatic cancer (12.42%). Further prospective studies are needed in the long term on larger study groups to evaluate the incidence and prevalence of various forms of cancer in the diabetic population.