Yildiz Tutuncu

Dimethylarginines in patients with type 2 diabetes mellitus: relation with the glycaemic control.

We tested the relationship between plasma levels of dimethylarginines (ADMA and SDMA) and glycaemic control in 43 type 2 diabetic patients. Type 2 diabetics with poor glycaemic control (HbA1c>6.5) had significantly lower SDMA and higher ADMA concentrations than those with well-controlled glycaemia (HbA1c<6.5).

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.

Impact of apolipoprotein E genotypes on phenotypic expression in Turkish patients with Wilson's disease

TO THE EDITOR: Wilson’s disease (WD) is a disorder characterized by excessive hepatic copper accumulation and impaired biliary copper excretion. This accumulation can result in severe neurological symptoms and liver disease. The wide spectrum of phenotypic features in WD cannot be predicted. In a study about the effects of ApoE genotypes on WD it is reported that onset was significantly delayed with ApoE o3/3 [1]. We sought to determine the feature of disease at presentation and ApoE genotype in Turkish patients with WD. Fifty-six patients (21 F, 35 M) with symptomatic WD were recruited and classified according to symptoms at presentation as either neurological or hepatic. WD was diagnosed on the basis of typical symptoms and the presence of biochemical indicators (plasma ceruloplasmin B200 mg/l, serum copper B10 mmol/l, liver copper concentrations 250 mg/g on biopsy). All patients were examined for the presence of Kayser-Fleischer rings in the cornea on split lamp examination. WD phenotype was classified according to the international consensus classification [2]. The neurological examination resembled the scoring system published by Oder et al. [3]. At least two neurological symptoms were diagnosed as neurological involvement, while liver involvement was assessed by liver function tests, ultrasonography and liver biopsy. The ApoE genotype was determined by polymerase chain reaction (PCR) using the ApoE amplification kit. In humans, the structural gene locus for plasma apolipoprotein E is polymorphic. Three common alleles, designated as o2, o3 and o4, code for three major isoforms in plasma designated as apoE2, apoE3 and apoE4, respectively. After amplification of the ApoE o alleles, genotyping was performed using a reverse hybridization technique. SPSS for Windows software version 13.0 was used for statistical analysis. Statistical analysis was performed using the x test. The criterion for statistical significance was pB0.05. Frequencies of ApoEo3 and ApoEo4 alleles in WD were not significantly different from those in controls (96 healthy persons, 43 F, 53 M) (x 0.08 and 0.31, respectively, both p 0.05). Of the 56 patients (21 F, 35 M) with symptomatic WD, 28 patients presented with neurological symptoms and 28 with hepatic symptoms. The distribution of ApoE genotypes in WD is ApoEo3/3 80.4%, o3/4 8.9%, o2/3 10.7%, o4/4 4.1%. None of our patients had the allele combinations ApoEo2/2 and o2/4. There were no significant differences in ApoE alleles and phenotypic features (either neurologic or hepatic) (Table I) (ApoEo2, x 0.39; ApoEo4, x 0.64). According to the gender classification of patients with WD, it was found that the hepatic phenotypic features were more common in female patients (n 14, 66%), whereas the neurologic phenotypic features were more common in the male patients (n 21, 60%) ( p 0.053 for both). The presence of Kayser-Fleischer rings is associated with the neurologic phenotype (x, p 0.01, Table I). The relation between Kayser-Fleischer rings and ApoE genotypes is not significantly different (ApoEo2 and ApoEo4, respectively p 0.50, p 0.90). The frequency of ApoE genotypes in Turkish patients with WD was not significantly different

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.

Branched-Chain Amino Acid Database Integrated in MEDIPAD Software as a Tool for Nutritional Investigation of Mediterranean Populations

Branched-chained amino acids (BCAA) are essential dietary components for humans and can act as potential biomarkers for diabetes development. To efficiently estimate dietary intake, we developed a BCAA database for 1331 food items found in the French Centre d’Information sur la Qualité des Aliments (CIQUAL) food table by compiling BCAA content from international tables, published measurements, or by food similarity as well as by calculating 267 items from Greek, Turkish, Romanian, and Moroccan mixed dishes. The database embedded in MEDIPAD software capable of registering 24 h of dietary recalls (24HDR) with clinical and genetic data was evaluated based on archived 24HDR of the Saint Pierre Institute (France) from 2957 subjects, which indicated a BCAA content up to 4.2 g/100 g of food and differences among normal weight and obese subjects across BCAA quartiles. We also evaluated the database of 119 interviews of Romanians, Turkish and Albanians in Greece (27–65 years) during the MEDIGENE program, which indicated mean BCAA intake of 13.84 and 12.91 g/day in males and females, respectively, comparable to other studies. The MEDIPAD is user-friendly, multilingual, and secure software and with the BCAA database is suitable for conducting nutritional assessment in the Mediterranean area with particular facilities for food administration.