Components Of Syndrome Research Articles

The spectrum of anti-GQ1B antibody syndrome: beyond Miller Fisher syndrome and Bickerstaff brainstem encephalitis.

Since the initial identification of Miller Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis (BBE),significant milestones have been achieved in understanding these diseases.Discoveries of common serum antibodies (IgG anti-GQ1b), antecedent infections, neurophysiological data, andneuroimaging suggested a shared autoimmune pathogenetic mechanism rather than distinct pathogenesis, leadingto the hypothesis that both diseases are part of a unified syndrome, termed "Fisher-Bickerstaff syndrome". The subsequent identification of atypical anti-GQ1b-positive forms expanded the classification to a broader condition known as "Anti-GQ1b-Antibody syndrome". An exhaustive literature review was conducted, analyzing a substantial body of research spanning from the initialdescriptions of the syndrome's components to recent developments in diagnostic classification and researchperspectives. Anti-GQ1b syndrome encompasses a continuous spectrum of conditions defined by a common serological profilewith varying degrees of peripheral (PNS) and central nervous system (CNS) involvement. MFS and BBE represent theopposite ends of this spectrum, with MFS primarily affecting the PNS and BBE predominantly involving the CNS.Recently identified atypical forms, such as acute ophthalmoparesis, acute ataxic neuropathy withoutophthalmoparesis, Guillain-Barré syndrome (GBS) with ophthalmoparesis, MFS-GBS and BBE-GBS overlap syndromes,have broadened this spectrum. This work aims to provide an extensive, detailed, and updated overview of all aspects of the anti-GQ1b syndromewith the intention of serving as a stepping stone for further shaping thereof. Special attention was given to therecently identified atypical forms, underscoring their significance in redefining the boundaries of the syndrome.

#1961 Cardiovascular-kidney-metabolic syndrome components and cardio-vascular disease mortality based on half-a-million Asian adults

Abstract Background and Aims The American Heart Association (AHA) has recently issued guidelines addressing the “Cardiovascular-Kidney-Metabolic (CKM) Syndrome” to mitigate cardiovascular diseases. In parallel, European healthcare entities have established the CaReMe (CArdioRenal and MEtabolic) Partnership, emphasizing interdisciplinary health concepts. This study aims to evaluate CKM prevalence and its associated components in a substantial Asian cohort, along with the risk of cardiovascular mortality. Method The investigation focused on a cohort of 565 940 participants aged 20 years and above enrolled in a health screening program in Taiwan spanning from 1994 to 2017. The study assessed cardiovascular disease (CVD) and cause-specific mortality related to CKM stages and its components—hypertension, diabetes, chronic kidney disease, metabolic syndrome, and hyperlipidemia. Multivariable Cox proportional hazards models were employed to calculate hazard ratios (HRs). Results In this cohort with more than half-a-million Asian adults, approximately 74.3% exhibit CKM syndrome, distributed as 28.1% in Stage 1, 38.9% in Stage 2, 4.9% in Stage 3, and 2.4% in Stage 4. Among individuals aged 50 and above, almost 90% had CKM. The CKM components—hypertension (20.5%), chronic kidney disease (CKD) (11.1%), hyperlipidemia (28.4%), metabolic syndrome (13.1%), and diabetes (5.5%)—display diverse prevalence rates. We identified 13,449 participants who had CVD mortality, and the median follow-up was 15 years. CKM predicts CVD mortality with a dose-response relationship: Hazard Ratios (HRs) for Stage 2 is 2.34 (95% confidence interval (CI): 2.06, 2.65); HR for Stage 3 is 2.69 (95% CI: 2.36, 3.07), and HR for Stage 4 is 4.70 (95% CI: 4.11, 5.39). Within CKM, 43.3% have two or more components, 20.4% have three or more, and 7.3% have four or more. In those aged 65 and above, 66.6% have two or more components, 37.9% have three or more, and 17.8% have four or more. Participants with two or more components exhibit a higher CVD mortality risk than those with a single CKM component. Conclusion The prevalence rates of CKM and its components vary, contributing to distinct risks of cardiovascular disease mortality. A clustering phenomenon exists among different components, where an increased number of clustered factors corresponds to a higher risk of cardiovascular disease mortality.

Possible pathogenetic features of the development and progression of osteoarthritis in the metabolic syndrome (diabetes mellitus, obesity, arterial hypertension)


 The paper emphasizes the pathogenetic features of osteoarthritis in the metabolic syndrome (type 2 diabetes, obesity, and arterial hypertension), such as the violation of the structure of the bone and cartilage tissue of the joints. Attention is paid to such mechanisms as oxidative stress, low-grade chronic systemic inflammation, and participation of the cartilage extracellular matrix, where matriline-3 protein plays an important role. It is involved in cartilage development and possible pathological mechanisms contributing to the onset and progression of osteoarthritis/osteoarthritis.
 The significance of abnormal levels of reactogenic forms of oxygen, superoxide anion, and nitrogen monoxide, which provide an increase in the level of peroxynitrite, hydrogen peroxide, myeloperoxidase, and hypochlorous acid, is discussed in detail. It is indicated that in the presence of iron and hydrogen peroxide, chondrocytes release hydroxyl radicals that react with unsaturated fatty acids of membranes and start a chain reaction, producing radicals with a long lifetime. This causes degradation of both the cellular and intercellular components of the cartilage. In addition, intra-articular connections are formed, and the vascular wall is restructured, leading to impaired microcirculation in bone and cartilage tissue due to damage to the vascular endothelium, vasospasm, increased blood clotting, the formation of microemboli, and venous occlusion. As a result, ischemia of the subchondral bone develops, along with damage to the cartilage tissue and a local disturbance of microcirculation. The thickness of the subchondral bone decreases due to angiogenesis at the junction of the articular hyaline cartilage and adjacent subchondral bone in patients with osteoarthritis. This process enhances degenerative-inflammatory changes in the structure of the cartilage due to a violation of metabolic processes in it.
 The importance of lipid and protein peroxidation in the regulation of intracellular calcium homeostasis and the ability of smooth muscles to undergo persistent contractions, which cause muscle pain, are emphasized. Pathogenetically, an important role in this process is played by the inhibition of calcium-ATPase in the sarcoplasmic reticulum, the activation of calcium flow through calcium channels, and an increase in intracellular calcium. Hypocalcemia and hypercalciuria in patients with metabolic syndrome contribute to the progression of not only osteoarthritis but other components of the syndrome.
 Attention is drawn to the significance of the cytokine link as an important mechanism for the onset and progression of osteoarthritis/osteoarthritis. The features of the reaction of chronic systemic inflammation with the participation of IL-18 and IL-10 in the structure of the extracellular matrix of cartilage, where matrilin-3 protein plays an important role since it is involved both in the development of cartilage and in the progression of osteoarthrosis, depending on multimorbidity with other components of metabolic syndrome, are highlighted.

Hyperuricemia as a predictor of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is currently a widespread disease among the adult population and, being a component of the metabolic syndrome (MS), is often associated with obesity, insulin resistance (IR), type 2 diabetes mellitus (DM2), cardiovascular diseases (CVD). Many authors in scientific studies have found that hyperuricemia (HU) can be considered as a predictor of non-alcoholic fatty liver disease (NAFLD), as well as other diseases associated with metabolic syndrome (MS).

Clinical and neuropsychological assessment of the condition of patients with post-mastectomy syndrome

Background. Post-mastectomy syndrome is a complex of symptoms that occurs in at least 80 % of women after treatment for breast cancer. The analysis of neurological disorders occurring in patients after antitumor treatment will increase the effectiveness of rehabilitation measures.Objective. To perform a clinical and neuropsychological assessment of the condition of patients with post-mastectomy syndrome.Design and methods. An open single-center uncontrolled study of the assessment of clinical and neuropsychological status in 45 patients with post-mastectomy syndrome was performed.Results. The components of the post-mastectomy syndrome are described, which, along with lymphedema of the upper limb, have a negative impact on the general health condition of the patients, lead to a violation of the psychosocial status, impaired adaptation and decreased life quality. In the clinical picture, a disorder of motor functions with a decrease in muscle tone, muscle strength, restriction of movements in the shoulder joint on the side of the operation, a violation of surface sensitivity on the medial surface of the shoulder was revealed.Conclusion. Studied patients developed anterior scalenus muscle syndrome (thoracic outlet syndrome), in the clinical picture manifested by pain, swelling, paresthesia and numbness of the upper limb on the side of the operation. Cerebrovascular disorders were manifested by vertebro-basilar insufficiency syndrome, which manifested in the form of headaches, dizziness, cognitive and emotional disorders.

1437-P: Waist-to-Height Ratio Is a Better Indicator Instead of Waist Circumference for Diagnosing Metabolic Syndrome in Type 2 Diabetes

Waist circumference (WC) is currently one of the components of metabolic syndrome (MetS) , but the cutoff points of WC for diagnosing MetS vary between races and genders. Therefore, the aim of this study is to search an anthropometric indicator instead of WC that would be applicable across races and genders. Our previous study found that a waist-to-height ratio (WHtR) >= 0.52 has excellent diagnostic value for MetS in both men and women with type 2 diabetes mellitus (T2DM) . We therefore selected 8525 T2DM patients with complete clinical data in the present study. Agreement between a WHtR >= 0.52 and different WC diagnostic criteria for men (>=90cm) and women (>=80cm) was almost perfect (Kappa=0.911) . As a component of MetS instead of WC, the AUC of new criteria using WHtR to diagnose MetS was 0.963 in T2DM patients. Using a WHtR cut-off of 0.52 most closely associated with the prevalence of MetS in man (98.0% sensitivity and 94.7% specificity) and women (95.7% sensitivity and 98.0% specificity) participants and. Taken together, the use of WHtR instead of WC is a simple and practical indicator for the diagnosis of MetS in T2DM. Disclosure J.Ke: None. J.Wang: None. Y.Ma: None. Y.Wang: None. L.Li: None. Funding National Natural Science Foundation of China (81770813, and 82070866) .

1121-P: The Combination of the ELF and FIB-4 Scores Have High Predictive Performance for Significant or Advanced Fibrosis in Patients with NAFLD

Background: Patients with nonalcoholic fatty liver disease (NAFLD) and fibrosis stage ≥ 2 (F2-F4) are at risk for adverse outcomes and considered to be candidates for clinical trials. We aimed to use two NITs combined to rule in and rule out fibrosis stages F2-F4 among patients with NAFLD. Methods: Data were collected from patients with NAFLD diagnosis. The Enhanced Liver Fibrosis (ELF) and FIB-4 NITs were calculated. Liver biopsies were read by 1 hepatologist; scored by NASH CRN criteria. Significant fibrosis stage was ≥ F2, advanced fibrosis was ≥ F3. Results: There were 463 NAFLD patients: 48±13 years old, 31% male, 35% type 2 diabetes, 39% had significant fibrosis and 24% advanced fibrosis. In comparison to those without significant fibrosis, patients with significant fibrosis were older (mean age 52 vs. 45 years) , more commonly male (38% vs. 26%) , and had more components of metabolic syndrome (type 2 diabetes, hypertension, hyperlipidemia) as well as higher ELF and FIB-4 scores; similar trends were observed for patients with vs. without advanced fibrosis (p<0.05) . The performance of the two NITs in identifying NAFLD patients with significant fibrosis was as follows: AUC (95% CI) = 0.78 (0.74-0.82) for ELF, 0.79 (0.75-0.83) for FIB-4; for advanced fibrosis AUC = 0.81 (0.77-0.85) for ELF, 0.83 (0.79 - 0.86) for FIB-4. A combination of ELF score ≥9.8 and FIB-4 ≥1.96 returned PPV of 95% which can reliably rule in significant fibrosis (sensitivity 22%, specificity >99%) , while an ELF score ≥7.7 and FIB-4 ≥0.30 had NPV of 95% which can be used to rule out significant fibrosis (sensitivity 98%, specificity 22%) . For advanced fibrosis, similar rules were ELF ≥9.8 and FIB-4 ≥2.90 (PPV 95%, sensitivity 18%, specificity >99%) to rule in; ELF ≥7.2 and FIB-4 ≥0.74 (NPV 95%, sensitivity 92%, specificity 49%) to rule out. Conclusions: The combination of ELF and FIB-4 can provide an easy algorithm with high predictive value to detect significant or advanced fibrosis in NAFLD. Disclosure Z.Younossi: Consultant; Bristol-Myers Squibb Company, Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Quest Diagnostics, Siemens. S.Felix: None. T.Jeffers: Stock/Shareholder; Neurometrix. E.Younossi: None. F.Nader: None. A.Racila: None. B.P.Lam: Consultant; Intercept Pharmaceuticals, Inc. M.Stepanova: None.

1172-P: Higher Dairy Consumption Is Associated with Lower Risk of Type 2 Diabetes among U.S. Adults: A Nationally Representative Study

Dairy consumption has been associated with a modestly lower risk of type 2 diabetes and other components of the metabolic syndrome in few cohort studies. However, confounding by overall diet quality and physical activity levels remains present. We evaluated 4,934 adults who participated in the 2017-2018 National Health and Nutrition Examination Surveys (NHANES) and underwent two 24-hr dietary recalls in addition to general health questionnaires, examinations, and laboratory assessments. Dairy intake data (milk, yogurt, and cheese but not dairy-based desserts) were extracted and transformed into USDA-defined serving sizes then categorized based on number of servings: non-consumers, <1 serving, 1 to <2 servings, and ≥2 servings. We defined diabetes mellites (DM) as physician-diagnosed DM, A1c ≥6.5%, or fasting plasma glucose ≥126 mg/dL. We calculated the Healthy Eating Index-2015 (HEI-2015) , an indicator of overall diet quality. The average age of this cohort was 49.6±18.5 yrs, 51% were female, 73.5% were overweight or obese, and 17% had DM. After multivariate adjustment for age, gender, BMI, smoking, vigorous physical activity, and HEI-2015, intake of ≥2 servings of dairy was associated with lower risk of DM (OR: 0.9, 95% CI 0.81-0.99, p=0.049) compared with non-consumers. In sensitivity analysis, the association between intake of ≥2 servings of dairy and prevalent DM showed directionally dissimilar results when adding dairy type-specific servings to the model (Milk, OR: 0.9, 95% CI 0.77-1.05, p=0.vs. combined cheese and yogurt, OR: 0.87, 95% CI 0.76-0.99, p=0.036) . In conclusion, higher dairy intake is associated with lower risk of DM among US adults while adjusting for diet quality. This association seems to be driven by cheese and yogurt intake rather than by milk. These findings need to be evaluated in randomized prospective intervention trials. Disclosure S.Tomah: None. O.Hamdy: Advisory Panel; L-Nutra Inc., Nestlé, Consultant; Abbott, Sanofi, Research Support; Eli Lilly and Company, Gilead Sciences, Inc., National Dairy Council, Novo Nordisk, Stock/Shareholder; Healthimation. Funding The authors received specific funding for this research

179-LB: Characteristic Cluster of Metabolic Disorders in Relation to Risk of Cancer in Chinese Patients with Type 2 Diabetes

Aims: The study aimed to investigate the relationship between components of metabolic syndrome (MS) and risk of cancer in patients with type 2 diabetes (T2DM) . Methods: We enrolled 6587 patients with T2DM who were hospitalized in Qingdao Endocrine and Diabetes Hospital from Feb 2005 to Jan 2016. According to the number of MS component each patient had, they were divided into isolated T2DM, T2DM plus 1 component,2 components, 3 components and 4 components, respectively. The IDF Worldwide Definition of the Metabolic Syndrome was applied. Information on the diagnosis of cancer was obtained by matching ICD-10 codes recorded in local Healthcare medical records database. Prevalence of cancer was compared using Chi-square test. Logistic regression model was used to evaluate risk of cancer associated with MS. Results: The prevalence of cancer was 4.2% among 6587 patients with T2DM. Female patients had higher prevalence than did male in total or in the MS subgroup. The prevalence of cancer were 3.8%, 3.9%, 3.8%, 5.1% and 5.0% in isolated DM, T2DM plus 1 component of MS, T2DM plus 2, T2DM plus 3 and T2DM plus 4 components, respectively (P for trend <0.05) . Compared with those with less than 3 components, T2DM plus 3 or 4 components had increased risk of having cancer (OR=1.32, 95% CI: 1.04-1.69) . Among T2DM patients who had more than 3 components of MS, a specific cluster of increased waist, elevated triglycerides (TG) and decreased High-Density Lipoprotein Cholesterol (HDL-C) was associated with the highest prevalence of cancer (10.7%) , followed by 8.3% in T2DM patients plus hypertension, elevated TG and decreased HDL-C and 3.2% in T2DM patients plus hypertension, increased waist and elevated TG (χ2=26.6, P<0.05) . Conclusions: A cluster of metabolic disorders consisting of increased waist, elevated TG and decreased HDL-C seems to be oncogenic among Chinese patients with T2DM. For patients in combination with 3 or 4 MS components, it is important to conduct early cancer screening and prevention. Disclosure L. Zhang: n/a. J. Wang: None. Y. Yang: None. Y. Dong: None.

1130-P: A Prospective Cohort Study on the Predictive Value of Controlled Attenuation Parameter Measured by FibroScan to the Transition of Metabolic Status

Aims: Our previous study validated that controlled attenuation parameter (CAP) was a sensitive surrogate marker for evaluating metabolic derangement. However, prospective studies are needed to assess its usefulness for transition of metabolic status over time. In this study, predictive effect of CAP and its change over time was investigated by following up of medical staff volunteered for MAFLD study over 3 years. Subjects and Methods: Volunteers were recruited from our hospital to undergo FibroScan examination in 2018 and followed up in 2021. Anthropometric data, CAP and hematological indices for metabolic profiles and insulin resistance were collected. Metabolic syndrome (MetS) components were scored. CAP≥238 dB/m denoted hepatic steatosis. Number of MetS component increased by 1 or more was denoted ‘progression’ , whereas decreased by 1 or more denoted ‘regression’ of metabolic status. Results: A total of 922 subjects volunteered for FibroScan examination in 2018, and 466 of them were followed in 2021. At baseline, the median age was 49.0 years, BMI was 23.3kg/m2, waist circumference was 80cm. CAP were 240 (216, 275) dB/m, LSM were 3.9 (3.4, 4.7) Kpa, 242 (51.9%) subjects were with CAP≥238 dB/m. During the follow up, 124 (26.6%) subjects had progression, while 81 (17.3%) had regression of metabolic status. Logistic regression showed that CAP at baseline [1.0 (1.001, 1.011) , P = 0.019], change in waist circumference [1.1 (1.047, 1.165) , P = 0.000] and change in CAP [1.0 (1.004, 1.0150) , P = 0.001] were independent predictors for progression. In contrast, CAP at baseline [1.012 (1.006, 1.018) , P= 0.000], change in waist circumference [0.9 (0.857, 0.967) , P = 0.002] and change in LSM [0.813 (0.667, 0.990) , P = 0.040] were significant in predicting regression of metabolic status. Conclusions: CAP at baseline, changes in CAP and waist circumference are useful surrogate markers for predicting transition of metabolic status over time. Disclosure J.Li: None. Z.Huang: None. W.Deng: None. Z.Zhang: None. Y.Li: None. Funding National Natural Science Foundation of China (82070918)

Impact of cardiometabolic health and abdominal adipose tissue on physical function in women with breast cancer (WF-97415).

e18696 Background: Breast cancer treatments often result in a decline in physical function that may be worsened by high levels of abdominal adipose tissue (AAT). However, the role of cardiometabolic health, which is comprised of interrelated risk factors of insulin resistance, dyslipidemia, hypertension, and central adiposity, has been infrequently addressed. Thus, we evaluated the relationship between physical function and cardiometabolic health controlling for AAT in women with breast cancer before and during receipt of potentially cardiotoxic chemotherapy. Methods: Women recruited through NCORP with stage I-III breast cancer completed a six-minute walk distance (6MWD) test to determine physical function, magnetic resonance imaging (MRI) to evaluate AAT, and assessments of cardiometabolic health before and following 3 months of chemotherapy. Specifically, MRI was used to measure waist circumference (WC), and AAT components of subcutaneous (SAT) and visceral adipose tissue (VAT). To assess cardiometabolic health, individual metabolic syndrome (MetS) components of WC, mean arterial pressure (MAP), glucose (FPG), high-density lipoprotein cholesterol (HDL), and triglycerides (TG) were used to calculate a MetS severity z-score (MetS-Z) = [(WC-88)/SD] + [(MAP-100)/SD] + [(FPG-100)/SD] + [(50-HDL)/SD] + [(TG-150)/SD]. All measures were assessed by individuals blinded to visit, demographic data, and other components of the study. Baseline and 3-month data were compared via paired t-tests. Regression analyses were used to identify the relationship between 6MWD and MetS-Z and possible mediation effects of AAT (i.e., SAT and VAT). Results: One hundred eleven women with a mean age of 56.1 ± 11.0 yrs completed assessments. After 3 months of chemotherapy, 6MWD was lower (457 ± 90.7 vs 428 ± 92.9 m, P= 0.001) and MetS-Z was increased (-1.13 ± 3.01 vs 0.30 ± 3.97 AU, P< 0.001) compared to baseline. The increase in MetS-Z was mainly attributed to elevations in TG (120 ± 81 vs 154 ± 111 mg/dl, P< 0.001) and decreases in HDL (58.6 ± 14.3 vs 47.7 ± 13.9 mg/dl, P< 0.001). No changes were observed in SAT ( P= 0.15) or VAT ( P= 0.42). Although MetS-Z was associated with 6MWD at baseline ( P= 0.01), MetS-Z was not significant predictor after controlling for SAT and VAT (B = -3.39, P= 0.34, 95% CI [-10.4, 3.62]). MetS-Z also associated wtih 6MWD at 3 months ( P= 0.002) and this remained significant after controlling for SAT and VAT (B = -5.36, P= 0.03, 95% CI [-10.3, -0.46]). Conclusions: AAT may be more strongly associated with physical function prior to chemotherapy whereas cardiometabolic traits may have clinical implications during treatment in women with breast cancer. Additional longitudinal work investigating the effects of concurrent treatments (e.g., exercise, diet, pharmacological) on the relationship between cardiometabolic health and physical function is warranted. Clinical trial information: NCT02791581.

Obesity and Insulin Resistance Components of Metabolic Syndrome Induced by High-fructose Diet in Wistar Rats could be attenuated by Spices-Supplemented Diets

Constant consumption of fructose-sweetened diets and beverages has led to increasing incidences of metabolic disorders such as metabolic syndrome (MS). This research was designed to evaluate the potentials of supplementing diets with some locally available spices in ameliorating obesity and insulin resistance in induced metabolic syndrome. Thirty out of thirty-five rats weighing 128.08±5.29g were induced with MS, divided into six groups and treated with diets supplemented with powders of garlic, ginger, turmeric, black pepper and equal mixture of the spices while the other 5 rats were maintained on normal diet throughout the experiment. The weight and blood glucose were recorded weekly, while serum insulin level was determined on the 56th day of the treatment after which HOMA-IR was computed. The group of MS-induced rats fed normal diet had significantly (p<0.05) higher weekly average weight gain of 11.43g±0.63g compared with other groups. Our data show that blood glucose level (mmol/L) ranged from 4.61±0.22 - 5.99±0.17; Insulin (μU/mL) 8.00±0.41 - 22.00±0.58 and HOMA-IR 1.65±0.14 - 5.47±0.07. The treated groups had significantly (p<0.05) higher percentage decrease in blood glucose and HOMA-IR when compared with the control but all the MS-induced rats maintained on supplemented diets had significantly (p<0.05) lower blood glucose and HOMA-IR when compared with MS-induced rats maintained on normal diet. From our finding, obesity and insulin resistance due to consumption of MS-causing diets could be ameliorated by consumption of diets fortified with any of the four spices, but fortification with a blend of the spices could give a better result.

Characterization and assessment of endothelial dysfunction in adolescents with obesity and vitamin D deficiency

Background. Obesity and vitamin D deficiency in children are widespread in economically developed countries. Among children with obesity and components of the metabolic syndrome, vitamin D deficiency is more common than in children with a normal body mass index (BMI). The growth of metabolic disorders, atherosclerosis, early onset of type 2 diabetes mellitus lead to fatal vascular accidents in young people, and therefore the search for new ways of early diagnosis of these processes is relevant.
 Aim. To study of the relationship of endothelial dysfunction with vitamin D deficiency, obesity and associated metabolic disorders among adolescents in Saint Petersburg.
 Materials and methods. 5 adolescents aged 1416 years (150.76 years) with primary obesity were examined. Anthropometric parameters were studied: waist circumference, weight, height, calculation of BMI, stage of puberty according to Tanner. Laboratory examination included the following parameters: serum glucose, cholesterol, triglycerides, high density lipoproteins, low density lipoproteins, insulin, 25(OH)D. Atherogenicity index (AI), insulin resistance index (HOMA-IR), vitamin D sufficiency were calculated. Endothelial function was assessed by the value of the reactive hyperemia index (RHI), automatically calculated by the EndoPAT 2000 device (Itamar Medical, Israel).
 Results. All examined patients had abdominal obesity (median BMI 33.5 kg/m2 [30.9; 34.2]) and reduced vitamin D supply (median 25(OH)D 17.2 ng/ml). Hypercholesterolemia and dyslipidemia due to an increase in low density lipoproteins were diagnosed in 1 (20%) case. Dyslipidemia due to a decrease in high density lipoproteins was detected in 3 (60%) patients. An increase in IA was found in 4 (80%) people. Insulin resistance was present in 60% of the examined, the median value of HOMA-IR was 5.6. The median RHI was 1.74 [1.72; 2.13]. Optimum RHI values were observed in 2 (40%) patients; in most (60%) adolescents, the RHI values corresponded to subnormal values and were close to the lower limit of this zone. A significant inverse correlation of RHI with AI was obtained (R=-0.63, p0.05).
 Conclusion. Taking into account the risk factors previously identified in the examined patients (dyslipidemia, insulin resistance, reduced vitamin D supply), endothelial dysfunction in these patients was regarded as a cardiovascular risk factor. A manageable risk factor is a reduced supply of vitamin D, which can be corrected by an additional donation of cholecalciferol.

The effects of Long-term (five years) prednisone therapy in frequently relapsing nephrotic syndrome of childhood: impact on glycemia and the different components of the metabolic syndrome (MetS)

The effects of Long-term (five years) prednisone therapy in frequently relapsing nephrotic syndrome of childhood: impact on glycemia and the different components of the metabolic syndrome (MetS)

Differential Effects of Sleep Disturbance and Malnutrition on Late-Life Depression Among Community-Dwelling Older Adults.

BackgroundLate-life depression is a complex phenomenon that cannot be fully understood simply as depression occurring in older adults, prompting researchers to suggest that it represents a component of geriatric syndrome. Given the inherent complexity and multifactorial nature of geriatric syndrome, understanding the interactions between the comorbid conditions involved is important for establishing appropriate preventive strategies. While sleep disturbance and malnutrition are common manifestations of geriatric syndrome, they have also been regarded as indicators of late-life depression. However, the differential effects of sleep disturbance and malnutrition on late-life depression and their interrelationships remain unclear.ObjectiveThe objective of this study was to examine the effects of sleep disturbance and malnutrition on depression and the interactions between them among community-dwelling older adults.MethodsSleep disturbance and malnutrition in 1,029 community-dwelling older adults from Suwon Geriatric Mental Health Center were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Mini Nutritional Assessment (MNA), respectively. The Korean version of the Short Form of the Geriatric Depression Scale (SGDS-K) was used to evaluate depressive symptoms. Sociodemographic parameters were recorded. A multiple linear regression analysis was conducted to examine the effects of sleep and nutrition on depressive symptoms after adjusting for covariates. The effect size and conditional effects of sleep disturbance and malnutrition on late-life depression were assessed using Cohen’s f2 values and the Johnson–Neyman technique, respectively.ResultsAfter possible confounders were adjusted, the SGDS-K score was positively associated with the PSQI score (standardized beta = 0.166, P < 0.001) and negatively associated with the MNA score (standardized beta = −0.480, P < 0.001). The local effect size of the associations was small for PSQI and medium for MNA. A significant interaction was observed between the PSQI and MNA scores. The result of the Johnson–Neyman technique indicated that the influence of PSQI on SGDS-K became weaker and insignificant as nutritional status worsened. However, the association between the MNA and SGDS-K scores was significant regardless of PSQI.ConclusionBoth sleep disturbance and malnutrition were significantly associated with late-life depression, although malnutrition may be more critically associated with depression than sleep disturbance in community-dwelling older adults.

Algorithm for the diagnosis of subclinical hypercortisolemia in patients with adrenal incidentalomas and their implementation in MS Excel environment

Objective — to optimize the diagnosis of subclinical endogenous hypercortisolemia and develop a diagnostic algorithm in patients with adrenal incidentalomas based on the analysis of anamnestic, clinical, instrumental and laboratory studies. Materials and methods. The study of 310 patients operated for adrenal incidentalomas included a clinical assessment of the presence of components of the metabolic syndrome (obesity, hypertension, carbohydrate metabolism disorders, dyslipidemia) and indicators of hormonal activity of adrenal glands (plasma adrenocorticotropic hormone (ACTH) levels, daily cortisol excretion, cortisol levels after 1 mg dexamethasone suppressive test, aldosterone, renin levels). The examination was performed according to algorithm developed in accordance with the international clinical guidelines for the diagnosis of Cushing’s syndrome and recommendations for confirming autonomous cortisol production. To perform the analysis, patients were divided into groups according to the data of the pathohistological study after surgery: Group 1 included 244 patients (78.7 %) with hormonally active adenomas; Group 2 included 66 patients (21.3 %) who confirmed hormonally inactive formations. Laboratory tests included determination of cortisol, blood aldosterone with electrochemiluminescence analysis on an automatic analyzer immunoassay-photometer Cobas e411 (Roche Diagnostics, Germany); ACTH, plasma renin, cortisol in daily urine by enzyme immunoassay on an IEMs Reader MF&amp;MULTISKAN device (ThermoLabsystems, Finland); MSCT NC (tomograph Toshiba Corporation, Japan). Pathomorphological examination of adrenal formations was performed by light microscopy. Statistical processing of the results was performed using parametric and nonparametric methods (student's t-criterion, Mann-Whitney criterion, chi-square criterion, Fisher angular transformation, Spearman rank correlation, ROC analysis). When constructing the diagnostic algorithm, an inhomogeneous sequential Wald procedure was used. For data accumulation and processing, we used the MS Excel 2013 program and its appendices, as well as the statistical analysis program StatPlus Pro v. 7 (Analyst Soft Inc., USA, license No. 21735752). Results. Women prevailed in both groups. Comparative analysis proved a significant age difference: patients with hormonally active adenomas were older, most of these patients had hypertension (68.4 % vs. 36.4 %, p &lt; 0.05) and DM2 — 27 % vs. 13.6 % (p &lt; 0.05). Concomitant hyperaldosteronism was confirmed in 36 patients (22.5 %). There is a significant difference between the study groups in the indicators of lipid metabolism — cholesterol and low-density lipoproteins. According to the results of ROC analysis, the test using a cortisol level of 1 mg — DST has a sensitivity of 90 %, specificity of 74 % with a limit level of 1.7 mcg/dL. The second most important screening test for confirming subclinical hypercortisolemia was ACTH — at the limit level ≤ 10 pg/ml, it had a sensitivity of 80 %, specificity of 56 %; the indicator of daily cortisol excretion had a sensitivity of 71 %, specificity of 82 %. Using the method based on the heterogeneous sequential Wald procedure, an integral model was developed to confirm or exclude hypercortisolemia in a patient with incidentaloma. The assessment included indicators that demonstrate the highest clinical and laboratory diagnostic quality — age, presence of hypertension, DM2, overweight, dyslipidemia and laboratory indicators that have the highest sensitivity and specificity — cortisol 1 mg DST, ACTH, daily cortisol excretion. To automate a sequential procedure, a spreadsheet has been created in the MS Excel program using built-in mathematical and logical functions, which significantly simplified the decision-making procedure. Conclusions. To confirm the presence of subclinical endogenous hypercortisolemia in a patient with one/two-sided adrenal incidentalomas, it is advisable to use an integral diagnostic algorithm, which includes the sum of anamnestic (age, gender), clinical (presence of hypertension, DM2) and laboratory (cortisol level 1 mg DST, ACTH, excretion of cortisol, glucose, cholesterol, LDL) indicators. The use of the developed diagnostic model makes it possible to confirm or exclude autonomous cortisol production in a patient with NC incidentaloma with a sensitivity of 94.9 % and a specificity of 83.3 %; the overall diagnostic effectiveness of the method (with 12 % of undefined diagnoses) is 84.9 %.

Frequency of in-Hospital Mortality in Acute Myocardial Infarction Patients with Metabolic Syndrome

Background: Metabolic syndrome is one of the major public health issues worldwide. It is a pattern of physical conditions and metabolic abnormalities, commonly occurring together and increases an individual's risk of developing type 2 diabetes mellitus and atherosclerotic cardiovascular disease. Aim: To determine the frequency of in hospital mortality and in acute myocardial infarction patients with metabolic syndrome and its association with components of metabolic syndrome. Study Design: Prospective cross-sectional study Place and Duration of Study: National Institute of Cardiovascular Diseases (NICVD), Karachi from 1st May 2019 to 31st December 2020. Methodology: Two hundred and ten patients with acute myocardial infarction were taken and assessed for metabolic syndrome. Participants of either gender having age 18-70 years were included in the study. Demographic, clinical characteristics and in-hospital mortality were recorded. Results: Mean age of the participants was 55.68±7.81 years. Total 88 (~41%) were female and 122 (~58%) were male. Thirty two (15.2%) participants had in-hospital mortality. Moreover, the in-hospital mortality was associated with higher age, waist circumference, and high triglyceride levels with p values &lt;0.05. Conclusions: The waist circumference and high triglyceride component of metabolic syndrome were found to be associated with high mortality in patients who presented with acute myocardial infarction. It is essential therefore for focus on these modifiable risk factors associated with higher mortality as a secondary prevention strategy. Keywords: In-hospital mortality, Cardiovascular diseases, Metabolic syndrome, Myocardial infarction

Craniopharyngioma and Metabolic Syndrome: A 5-Year Follow-Up Single-Center Experience.

Patients with craniopharyngioma often have comorbidities, such as obesity and hypopituitarism. These two conditions affect each other and worsen the quality of life of patients, which lead to a higher risk of morbidity and mortality. In addition, abdominal obesity, measured as waist circumference (WC), is together with other parameters [arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduced levels of high-density lipoprotein (HDL) cholesterol], one of the components of metabolic syndrome (MS). Each one of these morbidities occurs in patients with craniopharyngioma more frequently than in the remaining population. On these bases, we evaluated metabolic parameters in patients with craniopharyngioma at the time of diagnosis and after a 5-year follow-up, which compares these data with those of age-, gender-, WC-, and body mass index (BMI)-matched controls. In addition, we evaluated the prevalence of MS according to IDF criteria (MS-IDF) and the prevalence of MS according to ATP III (MS-ATPIII) criteria in patients and controls at baseline and after 5 years. We recruited 20 patients with craniopharyngioma (age 38.5 ± 15 years, 10 M) and 20 age-, gender-, WC- and BMI-matched controls (age 34.16 ± 13.19 years, 10 M). In all patients and controls, we evaluated the following: anthropometric features [height, weight, BMI, WC, hip circumference (HC) and waist-to-hip ratio (WHR)], systolic blood pressure (SBP) and diastolic blood pressure (DBP), lipid profile [total cholesterol (TC), HDL, low-density lipoprotein (LDL) cholesterol, triglycerides (TG)], and blood glucose at baseline and after 5 years. The prevalence of MS, according to IDF and ATPIII criteria, was calculated in the two groups at baseline and after 5 years. According to our results, at baseline, patients with craniopharyngioma had a worse metabolic profile than controls and a higher prevalence of MS. Besides, at a 5-year follow-up, patients still had impaired metabolic characteristics and more frequent MS (according to IDF and ATPIII criteria) when compared to controls. These data confirm that MS in patients with craniopharyngioma is unresponsive to life-changing interventions and to a common pharmacological approach. Other factors may be involved in the evolution of these conditions; so, further studies are needed to establish the correct management of these patients.

Abstract P175: Combined Metabolic Health And Obesity Status Is Associated With Markers Of High-Density Lipoprotein Metabolism: Dallas Heart Study

Introduction: While high-density lipoprotein (HDL) cholesterol is a component of metabolic syndrome, an ASCVD risk factor, other markers of HDL metabolism better associate with ASCVD. However, it is unclear whether these markers better discriminate between metabolic health and obese groups. Hypothesis: We hypothesized that higher cholesterol efflux capacity (CEC) and a favorable HDL profile would be associated with metabolically healthy profiles within each weight category. Methods: Data from the second phase of the Dallas Heart Study were used to classify participants (n=2156) into four groups based on a harmonized definition of metabolic health and obesity status: Metabolically Healthy, Normal Weight (MHNW); Metabolically Unhealthy, Normal Weight (MUNW); Metabolically Healthy, Obese (MHO); Metabolically Unhealthy, Obese (MUO). MU was classified as having one or more of the following: elevated blood pressure (SBP/DBP ≥130/85 mmHg), fasting glucose (≥100 mg/dL), or fasting triglycerides (≥150 mg/dL); a history of CVD or diabetes; or any medications for these conditions. Obesity was defined as BMI ≥ 30kg/m 2 . CEC was measured using J774 macrophages, BODIPY- and radio-labeled cholesterol, and apoB-precipitated plasma. HDL particle (HDL-P) subfractions were quantified by NMR spectroscopy. Generalized linear models were used to compare paired means of CEC and HDL traits between groups controlling for age, sex, race, and smoking. Results: Small HDL-P concentration was higher in MU groups regardless of weight status. Total and medium HDL-P concentrations and radio-labeled CEC were higher in NW groups, regardless of metabolic health status. Mean HDL-P size and large HDL-P concentrations were different across all groups, with the rank order being MHNW, MUNW, MHO, MUO (Table 1). Conclusions: In conclusion, associations between HDL subfractions, CEC and metabolic/weight status are heterogeneous, highlighting the complexity of HDL physiology as it pertains to body weight and metabolic disease.

Exploring interactions among clustered components of Metabolic Syndrome with diabetes and prediabetes in The Study of Cardiovascular Risk Factors in Adolescents – ERICA Study

Exploring interactions among clustered components of Metabolic Syndrome with diabetes and prediabetes in The Study of Cardiovascular Risk Factors in Adolescents – ERICA Study