Jagoda Jorga

Relationship between peripheral arterial disease and metabolic syndrome.

The aim of the study was to estimate the prevalence of metabolic syndrome among 388 patients with peripheral arterial disease, to determine the relationship between the number of metabolic syndrome components (metabolic syndrome score) and the degree of established and some of the emerging vascular risk factors, and to estimate whether there was any relationship of metabolic syndrome score and other vascular risk factors with the severity of peripheral arterial disease clinical manifestations. Metabolic syndrome was present in 59.8% of the patients with peripheral arterial disease. All metabolic syndrome components were significantly related to metabolic syndrome score. The same was true for the body weight, body mass index, percentage of body fat, total cholesterol/high-density lipoprotein cholesterol ratio, uric acid, and percentage of patients with high-sensitivity C-reactive protein. The metabolic syndrome score was also significantly, but inversely, related to high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and smoking. The degree of peripheral arterial disease clinical manifestations was not related to metabolic syndrome score, but gangrene was significantly positively associated with increased fasting glucose, high-sensitivity C-reactive protein, and lower education.

New International Classification of Functioning, Disability and Health.

The rheumatologic community is in a leading position for the development of International Classification of Functioning, Disability and Health (ICF) Core Sets and the research into the validity and application of the ICF. We can be proud of this achievement, but not all of us are aware of this new development. What is the ICF? Rheumatologic conditions have major impact on patients. Apart from symptoms such as pain, stiffness, and fatigue, patients are limited in activities and restricted in participation in society [2]. When unable to continue paid work, for example, there are important consequences for the patients, their families, but also for society. A major goal of the management of rheumatic diseases is to maintain or restore functioning. This contributes to the well-being of the patients, their families, and other caregivers. It is clear that maintaining function requires more than control of disease activity. By using the ICF, which was developed by the World Health Organization (WHO), we can obtain information on all three areas that are important for global functioning: body functions and structures, activities (actions by an individual), and participation (involvement in life situations) [3]. The ICF is one of the three reference classification systems that were proposed and developed by the WHO and belong to the Family of International Classifications. The main aim of the classification systems is to improve integration of health information. The International Classification of Diagnosis (ICD) is well known and widely applied [4]. The ICF was developed from the older International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and accepted in 2001 [3]. It is increasingly recognized as an important classification in clinical medicine, outcome research, and healthcare organization. The International Classification of Health Interventions (ICHI) is proposed as the newest member of the family, and its development has just started [1]. The WHO aims to implement effectively the ICF worldwide and formulated strategic directions in which the three following are the most relevant: (1) The ICF has to become the framework to classify function, (2) easy-to-use ICF linked instruments should be developed to assess functional outcome as well as effectiveness of interventions, and (3) the level and quality of implementation of the ICF should be improved to increase quality and comparability Clin Rheumatol (2007) 26:1803–1808 DOI 10.1007/s10067-007-0623-0

Environmental factors, health-related habits, and serum selenium levels in cancer patients and healthy controls.

Previous studies conducted in Yugoslavia indicated that the concentration of selenium in soil, food items, and serum of the population is very low. The aim of the study was to investigate the possible relationship among environmental, health-related habits, nutrition, and selenium serum levels in cancer patients and the healthy population.The case-control study included a group of cancer patients and a matched group of healthy controls: 57 cancer patients and 41 healthy controls living in Stari Grad (an urban area of Belgrade), as well as 17 cancer patients and 13 healthy controls living in Barajevo (a rural community in the vicinity of Belgrade). The healthy controls were matched to cancer patients in sex and age; they were not blood related.The selenium serum levels were measured by atomic absorption spectrophotometry. Health-related habits and relevant dietary factors (“food frequency” method) that may influence the selenium serum levels were assessed by questionnaires.The differences in average values of selenium serum levels between the cancer patients and healthy controls were not significantly different, but both were below the lowest recorded in referential studies. A significant difference between the values obtained from urban and rural subgroups was noted.The most important factors that influenced the level of selenium included the residence place in the region with selenium deficiency (Barajevo), age, associated chronic diseases, and some dietary factors potentially related to the intake of selenium. The results obtained in this investigation pointed out that use of selenium supplementation in this area should be seriously considered.

The Relationship Between Weight Loss and Health‐related Quality of Life in a Serbian Population

We examined changes in weight-specific health-related quality of life (HRQOL) and the relation to weight loss in a Serbian population undergoing diet-induced weight loss treatment. HRQOL was assessed at intake and after 1 year using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. Study sample consists of 135 obese patients. After 1 year of diet therapy, patients experienced an average weight loss of ~12%, and significant improvements were noted in all IWQOL-Lite domains (Physical Function, Self-esteem, Sexual Life, Public Distress and Work). Amount of weight loss was closely linked to all domains (F = 27.49; p < 0.001), except Sexual Life (F = 2.08; p = 0.108). In patients with weight reductions of 5%-9.99%, there was a great improvement in physical function and self-esteem. In those with ≥10% weight loss, there was improvement in all dimensions of IWQOL-Lite. With the prevalence of obesity rising worldwide, including in Serbia, the positive effects of weight loss on weight-specific HRQOL are encouraging.

Prevalence of the metabolic syndrome in patients with carotid disease according to NHLBI/AHA and IDF criteria: a cross-sectional study.

BackgroundMetabolic syndrome (MetS) has been related to type 2 diabetes and cardiovascular diseases. Different criteria for diagnosis of MetS have been recommended, but there is no agreement about which criteria are best to use. The aim of the present study was to investigate agreement between the National Heart, Lung, and Blood Institute, American Heart Association (NHLBI/AHA) and the International Diabetes Federation (IDF) definitions of MetS in patients with symptomatic carotid disease and to compare the frequency of cardiovascular risk factor in patients with MetS diagnosed by these two sets of criteria.MethodsThe study was a cross-sectional one involving 644 consecutive patients with verified carotid disease who referred to the Vascular Surgery Clinic Dedinje in Belgrade during the period April 2006 - November 2007. Anthropometric parameters blood pressure, fasting plasma glucose and lipoproteins were measured using standard procedures.ResultsMetS was present in 67.9% of participants, according to IDF criteria, and in 64.9% of participants, according to the NHLBI/AHA criteria. A total of 119 patients were categorized differently by the two definitions. Out of all participants 10.7% had MetS by IDF criteria only and 7.8% of patients had MetS by NHLBI/AHA criteria only. The overall agreement of IDF and NHLBI/AHA criteria was 81.5% (Kappa 0.59, p < 0.001). In comparison with patients who met only IDF criteria, patients who met only NHLBI/AHA criteria had significantly more frequently cardiovascular risk factors with the exception of obesity which was significantly more frequent in patients with MetS diagnosed by IDF criteria.ConclusionThe MetS prevalence in patients with symptomatic carotid disease was high regardless of criteria used for its diagnosis. Since some patients with known cardiovascular risk factors were lost by the use of IDF criteria it seems that NHLBI/AHA definition is more suitable for diagnosis of MetS. Large follow-up studies are needed to test prognostic value of these definitions.

Relationship Between High-Sensitivity C-Reactive Protein and Risk Factors in Patients With Peripheral Arterial Disease—A Cross-Sectional Study

We investigated whether patients with peripheral arterial disease (PAD) with various serum levels of high-sensitivity C-reactive protein (hsCRP) differ in the frequency of atherosclerotic risk factors. Among 388 patients, hsCRP levels were (1) low, <1 mg/L, in 41 (10.6%) participants; (2) medium, from 1 to 3 mg/L, in 152 (39.2%) participants, and (3) high, >3 mg/L, in 195 (50.2%) individuals. According to multivariate logistic regression analysis, in comparison with patients with hsCRP level ≤3.0 mg/L, those with higher hsCRP levels had more frequently a severe form of PAD (gangrene, P ranged from .045 to <.001; ankle–brachial index ≤.40, P = .059) and had more frequently some of atherosclerotic risk factors (metabolic syndrome, P = .007; hypertension, P = .013; abdominal obesity, P = .007; high levels of uric acid, P = .022; high level of fibrinogen, P < .001; and depression, P = .015).

Frequency and characteristics of metabolic syndrome in patients with symptomatic carotid atherosclerosis

BACKGROUND Metabolic syndrome (MetS) is associated with increased risk of carotid atherosclerosis. AIM To estimate the frequency of MetS in patients with symptomatic carotid atherosclerotic disease, and to compare clinical, biochemical and ultrasonographic characteristics of patients with and without MetS. MATERIAL AND METHODS Cross-sectional study of 657 consecutive patients (412 males) with symptomatic carotid atherosclerotic disease. Carotid atherosclerosis was estimated by high resolution B-mode ultrasonography. National Cholesterol Education Program (NCEP) M criteria were used for estimation of MetS. RESULTS Metabolic syndrome was present in 55.6% of studied patients. Among patients with metabolic syndrome there was a significantly higher proportion of women, and mean values of body weight, body mass index, waist circumference, percentage of body fat, systolic and diastolic blood pressure, serum triglycerides, total cholesterol and glucose were significantly higher. Mean values of high density lipoprotein cholesterol and alcohol consumption were significantly lower in patients with MetS. No differences between patients with or without MetS, were observed for age, smoking, mean values of low density lipoprotein cholesterol, high sensitive C-reactive protein and fibrinogen, and for degree of carotidstenosis or severity of clinical manifestations. CONCLUSION Half of these patients with carotid stenosis have features of the metabolic syndrome.

Factors mediating the depression in the adult obese outpatients

INTRODUCTION The prevalence of obesity is rising to epidemic proportions at the alarming rate in both developed and underdeveloped countries around the world. Current prevalence data from individual national studies suggest that the obesity prevalence in the European countries ranges from 10% to 20% for men, and 10% to 25% for women. Health consequences of obesity imply both a number of fatal and non-fatal health problems (out of which the most common are cardiovascular problems, non-insulin dependent diabetes mellitus, cancers), and also a wide spectrum of psychological consequences from diminished self-esteem to clinical depression. Causal relationship between obesity and many chronic diseases is evidence-based. At the same time, there are marked differences in research data regarding causal obesity-depression relationship. Several studies have found no direct association between obesity and depression, while in others the prevalence of depression in obese patients was up to 50%. Gender, obesity grade, socioeconomic status and asking for professional help are named as moderators and mediators of this relationship. Among recommended screening methods, BDI-II is the most frequently used in the adult outpatient departments. OBJECTIVE The aim of the study was to determine possible risk factors of depression in adult obese patients treated for obesity. Gender, obesity and education level as well as marital status were analyzed as possible moderators of depression-obesity relationship. METHOD The research included 267 patients, 38.0 +/- 14.6 years of age, who referred to the Outpatient Nutrition Department for dietetic consultation or nutritional medical therapy. Nutritional status was assessed by BMI (kg/m2), calculated from measured values of body weight and height according to WHO recommendations. An estimate of the existence and/or depression level was investigated by Beck Depression Inventory--self-administered questionnaire recommended for use in Serbian population. RESULTS The results revealed higher average BDI score values in obese patients (F(267,1) = 6.014, p = 0.015) in comparison to their non-obese counterparts. In addition, the percentage of depressive obese patients was significantly higher (55.1%, chi2(267.1) = 22.64, p < 0.001). There was significant correlation of BMI and BDI scores (r = 0.246, p < 0.001). The number of women with depression was significantly higher in comparison to men (chi2(267.1) = 4.261, p = 0.039). Women also had higher average BDI score (p = 0.003). MANOVA showed that BDI score was influenced by gender (F(267.1) = 8.936, p = 0.030) and nutritional status (F(267.1) = 6.115, p = 0.014), but combined effect of the above-mentioned moderators was not significant. CONCLUSION Depression is ten times more frequent in obese patients undergoing the obesity treatment vs. general population and, therefore, screening for depression is needed. Special attention should be paid to women and more obese patients due to higher incidence of depression in these groups.

Relationship Between Sociodemographic, Anthropometric and Biochemical Characteristics and Degree of Peripheral Arterial Disease

INTRODUCTION Peripheral arterial disease (PAD) is a severe atherosclerotic condition. The relationship between various risk factors and severity of PAD, measured by Ankle Brachial Index (ABI), has been the subject of a relatively small number of studies. OBJECTIVE The aim of the present study was to investigate whether there was any relationship between severity of PAD, expressed as ABI, and anthropometric, clinical and biochemical characteristics of patients, including inflammatory markers. METHODS The cross-sectional study, involving 388 consecutive patients with verified PAD, was performed at the Dedinje Vascular Surgery Clinic in Belgrade. The diagnosis of PAD was defined by Doppler sonography as ABI < 0.9, and by symptoms. Data on cardiovascular risk factors, anthropometric parameters, clinical and biochemical characteristics were collected for all participants. In the analysis, chi2 test, t-test and multivariate logistic regressions were used. RESULTS According to the results of multivariate analysis (the model of which included age, percentage of body fat, average value of uric acid, high sensitivity C-reactive protein--hsCRP > or = 3 mg/L, fibrinogen > or = 4 g/L, Baecke index of physical activity at work and Baecke index of leisure-time physical activity), the patients with more severe form of peripheral arterial disease (ABI < or = 0.40) had more frequently increased high sensitivity C-reactive protein (p = 0.002), lower Baecke index of physical activity at work (p = 0.050) and lower Baecke index of leisure-time physical activity (p = 0.024). Average value of body fat was significantly higher in the patients with a less severe form of disease (p = 0.006). CONCLUSION According to the results obtained, the increased values of hsCRP and physical inactivity are associated with a more severe form of PAD (ABI < or = 0.40).