Fasting Glucose Insulin Ratio Research Articles

Anti-Diabetic and Antioxidant Effects of Methanolic Flower Head Extract of Tagetes Patula in Streptozotocin and Dexamethasone Induced Diabetic Rats


 Diabetes is a chronic metabolic disorder characterized by a high blood glucose concentration, i.e., hyperglycemia or caused by insulin deficiency, often combined with insulin resistance. In the Present study, the antidiabetic and antioxidant activity of the methanolic extract of Tagetes patula flower heads was screened out in rodent models. The pharmacological evaluation was carried out using 200 and 400 mg/kg, b.w. The in-vivo antidiabetic activity was performed in streptozotocin, dexamethasone- induced diabetic models and oral glucose tolerance test. Metformin hydrochloride was used as a standard. The parameters like blood glucose levels, insulin levels, homeostasis assessment of insulin resistance, insulin sensitivity, and fasting glucose-insulin ratio were estimated in these models. The in-vitro antioxidant activity of methanolic extract of Tagetes patula was performed by using hydroxyl radical scavenging assay and Ascorbic acid was used as a standard. The preliminary phytochemical screening of Tagetes patula revealed the presence of phytoconstituents like alkaloids, flavonoids, saponins, steroids, phenols, carbohydrates, triterpenoids, and tannins. The extract showed a significant decrease in the elevated blood glucose levels in streptozotocin, dexamethasone-induced diabetic models, and also in the oral glucose tolerance test. The extract prevented insulin resistance and significantly increased insulin sensitivity in the dexamethasone-induced model. The various phytochemical constituents like alkaloids, flavonoids, saponins, steroids, and phenols might be responsible for lowering the blood glucose levels in the animal models mentioned above. The extract showed significant scavenging activity against hydroxyl free radicals. From the above outcomes, it is flawless that the methanolic extract of Tagetes patula has antidiabetic and antioxidant activities.

Lipid accumulation product (LAP) as a potential index to predict risk of insulin resistance in young, non-obese Asian Indian males from Southern India: observations from hyperinsulinemic-euglycemic clamp studies

IntroductionWe aimed to compare the predictive accuracy of surrogate indices namely the lipid accumulation product (LAP) index, homeostatic model of assessment of insulin resistance (HOMA-IR), fasting glucose-insulin ratio (FG-IR) and...

Correlation between Insulin Resistance and LVEF in non Diabetic Chronic Heart Failure Patients admitted in a Tertiary Care Hospital

Background: Insulin resistance is a well-established composite index of systemic inflammatory and metabolic disorders. A wide variety of methods like, HOMA-IR (Homeostatic model assessment insulin resistance), FGIR (Fasting glucose insulin ratio), ISI-Composite (an index of whole body insulin sensitivity), QUICKI (quantitative insulin sensitivity check index) etc are available for assessing IR. Objective: To find out the correlation between insulin resistance and LVEF in non diabetic chronic heart failure patients. Methodology: This cross sectional study was carried out in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka from February, 2019 to June, 2020. Patients admitted with chronic heart failure with reduced ejection fraction were included in this study. Patients with diabetic, prediabetic and patient who did not give written informed consent were excluded in this study. Results: LVEF 25-29% was 16 patients out of which 10(66.7%) had significant insulin resistance. LVEF 30- 34% was found in 28 patients, among them 16(41.0%) had no insulin resistance. LVEF 35-39% was found in 19 patients out of which 18(46.2%) had no insulin resistance. The difference was statistically significant (p<0.05). A negative correlation (r=-0.340; p=0.006) was found between insulin resistance and LVEF. Conclusion: Majority non diabetic chronic heart failure patients had no insulin resistance. Significant negative correlation was found between insulin resistance and LVEF.
 University Heart Journal Vol. 17, No. 2, Jul 2021; 99-102

Revisiting the pathogenic role of insulin resistance in Duchenne muscular dystrophy cardiomyopathy subphenotypes.

Duchenne muscular dystrophy (DMD) is known to impact the subepicardial layer of the myocardium through chronic inflammation. Recent animal studies have shown predominant subendocardial involvement in rats with DMD. The primary outcome parameter was to determine by cardiovascular MRI (CMR) if two differential patterns of myocardial involvements exist in DMD; the secondary outcome parameters were to correlate the observed pattern with metabolic markers such as insulin resistance measures. Forty patients with DMD were screened using CMR to determine which of them had predominantly subendocardial dysfunction (SENDO group), or subepicardial/midmyocardial involvement (SEPMI group). Patients were subjected to body mass index measurement, serum creatinine kinase, serum lactate dehydrogenase enzyme, fasting glucose-insulin ratio (FGIR), full lipid profile, left ventricular ejection fraction (LVEF), left ventricle E/E´ ratio (the ratio of early mitral inflow velocity to average early diastolic velocities of the basal septum and mitral annulus) for left ventricle diastolic function, and myocardial layer strain discriminating echocardiography (MLSD-STE). Results: 26 patients displayed SENDO while 34 displayed SEPMI. SENDO group displayed overt insulin resistance; (FGIR (SENDO: 7 ± 1 vs. SEPMI: 5 ± 1, P < 0.001). FGIR was negatively correlated with Subendocardial Global Longitudinal Strain (ENDO-LS) with r = -0.75. DMD does not seem to influence the heart uniformly; DMD cardiomyopathy probably has two separate phenotypes with different mechanisms. Insulin resistance might be implicated in its pathogenesis and its reversal may help to slow disease progression.

A study on carotid artery intima-media thickness and metabolic risk factors in overweight and obese Indian children.

Carotid intima-media thickness (CIMT) serves as an early marker of atherosclerosis. Data on obesity-related risk factors and their association with carotid intima-media thickness among overweight and obese children are lacking. To compare CIMT of overweight and obese children with CIMT of normal BMI children. To compare various anthropometric and metabolic risk factors associated with increased CIMT among overweight and obese children. A descriptive study in a paediatric department of a tertiary care hospital including 50 age-matched normal BMI children and 50 overweight and obese children. Anthropometric data, blood pressure, CIMT (by B-mode ultrasonography), fasting blood sugar, fasting Insulin, fasting lipid profile, TSH, and FT4 were collected. HOMA-IR and fasting glucose-insulin ratio (FGIR) were calculated for insulin resistance. Cutoff for high CIMT was derived using ROC curve analysis. Overweight and obese children had higher mean CIMT than normal BMI children (0.5 ± 0.1mm vs 0.34 ± 0.05mm, respectively, P < 0.001). ROC analysis revealed 0.45mm as the cutoff for high CIMT. Among overweight and obese children, 31 children (62%) had high CIMT. Among metabolic risk factors for increased CIMT, only FGIR was observed to be significant. Compared to overweight and obese children with normal CIMT, those with higher CIMT had low FGIR value (5.2 ± 2.2mm vs 6.9 ± 2.6mm, respectively, P < 0.05). Overweight and obese children had significantly higher CIMT than controls. Even among overweight and obese children, those with increased CIMT had low FGIR (implying insulin resistance) compared to those with normal CIMT.

Markers of insulin resistance and their performance in adult Nigerians with metabolic syndrome

Background: Insulin resistance (IR), which is a state of deficient response to normal insulin levels, is associated with metabolic abnormalities of dyslipidemia, glucose intolerance, obesity, and hypertension, parameters which define metabolic syndrome (MS). Markers of IR could be useful tools to predict MS. Aim: This study aims to evaluate the performance of surrogate markers of IR in predicting MS in nondiabetic adult Nigerians. Settings and Design: This cross-sectional, analytical study was conducted in Lagos, Nigeria. Subjects and Methods: One hundred and forty-one apparently healthy adult Nigerians aged between 40 and 80 years were consecutively recruited. MS was defined according to the harmonized MS criteria. Data were collected using a questionnaire, and fasting blood samples were collected for analysis. Statistical Analysis: The data were analyzed using the IBM SPSS statistical package. Statistical significance was set at P Results: The mean values of Homeostatic Model for Insulin Assessment-IR (HOMA-IR), HOMA-beta cell (HOMA-B), and Quantitative Insulin Sensitivity Check Index (QUICKI), but not fasting glucose-insulin ratio (FGIR), significantly distinguished individuals with and without MS components (P = 0.0001). HOMA-IR and QUICKI, but not HOMA-B and FGIR, had significant correlations with the components of MS (P = 0.041). QUICKI had the largest area under the receiver operating characteristic curve for predicting MS, with a sensitivity of 90% and a specificity of 40%, at a cutoff value of 0.324 (P Conclusion: QUICKI performed better than HOMA-IR, HOMA-B, and FGIR in predicting MS in apparently healthy adult Nigerians.

Insulin resistance linked to subtle myocardial dysfunction in normotensive Turner syndrome young patients without structural heart diseases.

Background Turner syndrome (TS) patients have increased cardiovascular risk. This cardiovascular risk is famously attributed to structural abnormalities of the left side of the heart such as aortic stenosis and aortic coarctation. However, due to insulin resistance and subsequent pathogenic mechanisms, normotensive TS patients without structural abnormalities may develop varying degrees of myocardial dysfunction. The aim of this research was to examine the role of speckle tracking echocardiography in early detection of Turner cardiomyopathy and to correlate this myocardial dysfunction with measures of insulin resistance. Methods This cross-sectional case control study included 30 children with TS and 30 age-matched healthy controls. TS patients were excluded if: hypertensive, with major structural abnormalities of the heart or other systemic diseases that may affect myocardial function. Conventional speckle tracking echocardiography and glucose-insulin ratio were performed for all study subjects. Results Routine echocardiographic parameters of left ventricular systolic function were similar in cases and controls while global longitudinal and circumferential strain (GLS and GCS) were lower in patients with TS than controls: (-13.2±1.1 vs. -18.3±2.4, p-value<0.000) and (-11.3±1.1 vs. -16.3±2.1, p-value<0.000), respectively. Fasting glucose:insulin ratio (FGIR) proved to be the best predictor of myocardial dysfunction in TS patients by multivariate analysis. Conclusions This study points towards the potential role of two-dimensional (2D) speckle tracking echocardiography in early detection of subtle systolic myocardial dysfunction in TS patients. It also points towards the implication of insulin resistance in precipitation of the observed dysfunction in TS patients.

Differential performance of surrogate indices of fasting insulin resistance in low-birthweight and normal-birth weight cohorts: Observations from Hyperinsulinaemic-Euglycaemic clamp studies in young, Asian Indian males

AimTo evaluate the predictive accuracy of surrogate measures of fasting insulin resistance/sensitivity like the Homeostasis model assessment for insulin resistance (HOMA –IR), Fasting glucose/insulin ratio (FG-IR), Quantitative insulin sensitivity check index (QUICKI), and the 20/fasting C peptide x fasting plasma glucose [20/(FCP × FPG)] index in comparison to M value derived from hyperinsulinaemic-euglycaemic clamp (HEC) studies in two birth weight based cohorts of Asian Indian males. MethodsHEC studies were performed in non-diabetic Asian Indian males (n = 117), born of normal birth weight (n = 59, birth weight > 2.5 kgs) and low birth weight (n = 58, birth weight < 2.5 kgs). Anthropometry and biochemical analysis were done. Surrogate indices of fasting insulin resistance were calculated and data were analysed by Pearson's correlation and Random calibration model analysis. ResultsAmongst surrogate indices of fasting insulin resistance/sensitivity, the mean values for HOMA-IR, QUICKI, FG-IR, 20/(FCP × FPG) index and M value were similar between the two groups. Significant positive correlation was observed for FG-IR and QUICKI with M value (the gold standard measure of insulin sensitivity derived from HEC procedure) in the low birth weight cohort in contrast to the normal birth weight cohort, wherein no significant correlation was observed for any of the indices. Random calibration model analysis showed highest predictive accuracy for QUICKI in both the study groups. ConclusionThe QUICKI index showed highest predictive accuracy in the normal birth weight and the low birth weight cohorts of Asian Indian males.

Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial.

To investigate the effect of chromium picolinate (CrP) on insulin resistance (IR) in polycystic ovary syndrome (PCOS). This double blinded randomized controlled trial was conducted in the Gynecology outpatient clinics at Ain Shams University Women's Hospital. Using closed and randomly mixed envelopes, 100 women were selected out of 400 PCOS patients. Eighty-five patients finished the study and were analyzed, 44 in group I and 41 in group II. They were randomly allocated to 6 months of either 1000 μg CrP (50 patients), or placebo capsules (50 patients). Patients were seen monthly to encourage similar diet control and physical exercise plans. The primary outcome was fasting glucose insulin ratio (FGIR), secondary outcomes included ovulation, regularity of the cycle, body mass index (BMI), fasting blood sugar (FBS), fasting serum insulin (FSI), and serum testosterone level. There were no significant differences between women of both groups regarding pretreatment levels of FBS, FSI, FGIR, and serum testosterone. Use of CrP for 6 months was associated with significant reduction of BMI (P < 0.001) and FSI (P = 0.007), and significant rise in FGIR (P = 0.045). CrP significantly increased the chances of ovulation (P = 0.011) and regular menstruation (P = 0.002) by almost twofold after the fifth month of treatment. Chromium picolinate is useful in PCOS to reduce IR and stimulate ovulation.

Should insulin resistance be screened in lean hirsute women?

The role of insulin resistance (IR) is well-documented in obese women with polycystic ovary syndrome (PCOS). Controversies exist concerning the presence of IR in idiopathic hirsutism (IH) or if it is a manifestation of high body mass index (BMI). We aimed to investigate the presence/absence of IR in lean hirsute women. One-hundred fifty-one lean women with hirsutism [96 PCOS (group 1) and 55 IH (group 2)] and 58 age-and BMI-matched healthy controls (group 3) were recruited in the study (mean age 25.21 ± 6.1 versus 26.26 ± 4.6years; BMI 21.79 ± 1.7 versus 22.02 ± 2.2 kg/m2, respectively). Significantly higher insulin and HOMA-IR, and significantly lower fasting glucose insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), reciprocal insulin, and Raynaud index were detected in groups 1 and 2 than in group 3 (p < 0.05). These IR indices were similar between groups 1 and 2. The number of patients with IR (HOMA-IR > 2, FGIR < 7.2, or QUICKI < 0.357) was significantly higher in groups 1 and 2 than in group 3, but was similar between groups 1 and 2. A higher frequency of IR occurs in lean hirsute women regardless of they having PCOS or IH. IR may contribute to aetiopathogenesis of IH, or may cause some metabolic abnormalities in these patients.

Prediction of gestational diabetes mellitus in the first trimester: comparison of C-reactive protein, fasting plasma glucose, insulin and insulin sensitivity indices

Objective: To develop a predictive index based on high sensitivity C-reactive protein (hs-CRP), fasting plasma glucose (FPG) and fasting plasma insulin (FPI) measurements for early diagnosis of gestational diabetes mellitus (GDM).Methods: Healthy pregnant women who were screened for GDM during their first antenatal visit were included in this retrospective cohort study. FPG, FPI and serum hs-CRP concentrations were measured between weeks 11 and 14. A two-step glucose challenge test was carried out between gestational weeks 24 and 28. Fasting glucose/insulin ratio (FIGR), Homeostatic Model Assessment Insulin Resistance (HOMA-IR), HOMA-β indices and Quantitative Insulin Sensitivity Check Index (QUICKI) were used to estimate insulin sensitivity and β-cell function.Results: Of the 450 women who were eligible for the study, 49 (11.2%) were diagnosed with GDM at weeks 24–28. The median FPG and hs-CRP levels were higher in the GDM diagnosed women compared to the others. Comparison of accuracy measures resulted in the highest specificity (87.2%; 95% CI 83.5–90.1) and diagnostic odds ratio (3.9; 95% CI 2.1–7.6) for hs-CRP.Conclusion: FPG and hs-CRP in the first trimester are correlated with later development of GDM in the pregnancy. In our study, FPG provided a better sensitivity while hs-CRP exhibited a better specificity for prediction of GDM.

Insulin resistance in patients on valproic acid: relation to adiponectin.

To investigate the presence of insulin resistance in obese children with idiopathic epilepsy on valproic acid (VPA) monotherapy in comparison to obese otherwise healthy subjects. Secondary outcome was to explore the relation between adiponectin and insulin resistance among those patients. Fifty obese children with generalized idiopathic epilepsy on VPA monotherapy and a control group of 49 obese clinically healthy age and sex-matched children with simple obesity were recruited in the study. Anthropometric assessment, fasting plasma insulin (FI), fasting glucose (FG) and fasting adiponectin levels were measured. Fasting glucose insulin ratio (FGIR) and homoeostasis model assessment for insulin resistance (HOMA-IR) were calculated for both patients and control subjects. Measurement of serum VPA trough level was also performed in patients. Patients had significantly higher fasting blood glucose, fasting insulin, lower FGIR and higher HOMA-IR values, compared to controls. Mean adiponectin level was significantly lower in patients compared to controls. The duration of treatment with valproic acid negatively correlated with adiponectin (r=-0.285, P=0.045), but did not correlate with fasting glucose, insulin, FGIR or HOMA-IR. Total daily VPA dose significantly correlated with fasting insulin (r=0.495, P<0.001), FGIR (r=-0.525, P<0.001) and HOMA-IR (r=0.404, P=0.004). This study ascertains the relationship between dose and duration of VPA therapy, insulin resistance and the adipocytokine axis. We are reporting the novel proposal that obese VPA-treated children are more insulin resistant and have lower adiponectin levels than obese and otherwise healthy children.

Polycystic ovarian disease in adult and perimenopausal women

Polycystic ovarian disease (PCOD) is most common endocrine disorder in women. Symptoms are variable and often involve more than one body function. The major clinical features are hirsutism, menstrual irregularities, obesity, insulin resistance, hyperinsulinemia, polycystic ovaries (PCO). Other characteristics include malepattern balding, acanthosis negricans, sleep apnea with increased risk for hypertension, cardiovascular disease, diabetes mellitus, endometrial carcinoma, and overproduction of ovarian androgens and luteinizing hormone. While some believe that PCOD disappears after menopause, symptoms can persist after menopause. The cause of PCOD is still unknown. Genetic studies suggest that transmission is autosomal dominant with decreased penetrance because of hypersensitive intra-ovarian-insulin-androgen signaling with disturbances in gonadotropin levels, hyperandrogenism, and reduced insulin sensitivity. Hyperinsulinaemia frequently stimulates lipid storage with alterations in lipoproteins, cholesterol, hyperlipidaemia obesity. Anti-Mullerian hormone might be responsible for these abnormalities. Information on PCOD in adult perimenopausal women is scarce as it may be difficult to diagnose, since one marker is irregular menstruation. PCO, a common feature of PCOD, may occur with or without other disorders and the associated obesity is of android (central) type with a waist-hip ratio (WHR) of > 0.8. Fasting glucose insulin ratio (FGI) has become a popular diagnostic criteria. Triglycerides, low-density lipoprotein (LDL), and cholesterol are elevated with decreased levels of sex hormone binding globulin (SHBG) due to hyperinsulinemia. The elevated levels of serum leptin and insulin and their linkage to obesity suggest the potentially complicated implications for obese patients. Preventative measures for PCOD are limited. Clinical management is primarily focused on treating symptoms and manifestations and preventing long-term complications. Oral contraceptive pills (OCP) have several benefits, including treatment of irregular menstruation. Insulin-sensitizing agents can ameliorate insulin resistance, endocrine, and metabolic reproductive abnormalities. Metformin has been extensively used and is not associated with an increase in insulin secretion or risk of hypoglycaemia. The weight loss that accompanies protracted therapy may account for some of the beneficial effects. Long-term follow-up is needed to determine the effectiveness in changing the metabolic outcomes without causing other complications, such as reducing hair growth. Management should include patient education, with particular attention to diabetes, cardiovascular risk, obesity and endometrial cancer.

The absence of insulin resistance in metabolic syndrome definition leads to underdiagnosing of metabolic risk in obese patients

This study explores in a group of obese children and adolescents aged 10 to 16 years, the prevalence of metabolic syndrome (MS) according to the criteria of International Diabetes Federation (IDF). In addition, the prevalence of insulin resistance (IR) was investigated to find correlations between MS and IR. IDF definition was compared to a modified WHO definition. A total of 159 obese patients (74 male and 85 female; median age 12.7 years) were included in the study. Anthropometric measurements, blood pressure, and serum fasting lipids were evaluated. An oral glucose tolerance test (OGTT) was performed, and serum glucose and insulin levels were measured at 0, 30, 60, 90, and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose/insulin ratio (FGIR), Matsuda index, and total insulin levels during OGTT were calculated. For the IR diagnosis, we used cutoff values described in previous publications (HOMA-IR of >3.16, QUICKI of <0.357, FGIR of <7, and/or the sum of insulin levels during OGTT of >300 mIU/mL). MS prevalence, defined according to IDF criteria, was 34.6 %. Using the IDF definition, there was no statistically significant difference for the surrogate IR indices between patients with or without MS (QUICKI, 94.5 vs. 83.7 %), FGIR (81.1 vs. 78.8 %), HOMA-IR (70.9 vs. 63.5 %), and total insulin levels during OGTT (61.8 vs. 51.9 %). The Matsuda index values, the prevalence of fasting hyperinsulinemia, and impaired glucose tolerance were also similar in these two groups. In conclusion, IR was prominent in obese patients with and without MS. IDF definition of MS fails to discover individuals with IR, unless it is specifically investigated.

Insulin production and resistance in cystic fibrosis: effect of age, disease activity, and genotype.

To assess the major determinants of glucose tolerance between age, genotype, and clinical status in cystic fibrosis (CF) patients, and study if defects of insulin secretion and insulin sensitivity were associated with the onset of CF-related diabetes (CFRD). One hundred and nineteen patients, in stable clinical condition were studied. They were subdivided into 3 groups based on age, and 2 groups based on Schwachman-Kulczycki clinical score. All patients were genotyped, and subsequently divided into 3 groups. Ninety-four healthy normal-weight controls, comparable for sex and age were also studied. All subjects had baseline blood samples taken for glucose and insulin, C-peptide, and glycated hemoglobin. Homeostasis model assessment of insulin resistance (HOMA-IR), fasting glucose/insulin ratio (FGIR) were calculated as indices of IR and insulinogenic index as a marker of pancreatic β-cell function. All patients underwent an oral glucose tolerance test, and 57 underwent an IVGTT for the calculation of first-phase (FPIR) and acute insulin responses (AIR). The F508del homozygous patients had an increased chance of developing impaired glucose tolerance (IGT) and significantly lower FPIR, decreased HOMA-IR, and insulinogenic index. Heterozygote F508del patients had an increased chance of having normal glucose tolerance. HOMA-IR, FGIR, and insulinogenic index did not change with age or clinical score. HOMAIR correlated with FPIR. FPIR correlated positively with insulinogenic index. AIR correlated negatively with FGIR, and positively with C-reactive protein. In multiple linear regression analyses, glucose tolerance was related to the agegroup, and to the HOMA-IR and insulinogenic indexes. IGT and CFRD were related mainly to genotype, although, as expected, the prevalence increased with age. The data suggested a possible combined contribution of insulin deficiency, β-cell function, and reduced insulin sensitivity to the onset of CFRD; however, further studies are warranted to better elucidate this aspect.

Regulatory Function of a Malleable Protein Matrix as a Novel Fermented Whey Product on Features Defining the Metabolic Syndrome

Previously, we reported that a malleable protein matrix (MPM), composed of whey fermented by a proprietary Lactobacillus kefiranofaciens strain, has immunomodulatory and anti-inflammatory properties. MPM consumption leads to a considerable reduction in the cytokine and chemokine production (tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6), thus lowering chronic inflammation or metaflammation. Inhibition of metaflammation should provide positive impact, particularly in the context of dyslipidemia, insulin resistance, and hypertension. In this study, we investigated whether short-term MPM supplementation ameliorates those features of metabolic syndrome (MetS). The ability of MPM to potentially regulate triglyceride level, cholesterol level, blood glucose level, and hypertension was evaluated in different animal models. MPM lowers triglyceride level by 37% (P < .05) in a poloxamer 407 dyslipidemia-induced rat model. It also reduces total cholesterol by 18% (P < .05) and low-density lipoprotein-cholesterol level by 32% (P < .05) and raises high-density lipoprotein-cholesterol level by 17% (P < .01) in Syrian Golden hamsters fed a high fat/high cholesterol diet for 2 weeks. MPM reestablishes the fasting glucose insulin ratio index to normal levels (P = .07) in this latter model and lowers the plasma glucose level area under the curve (-10%, P = .09) in fructose-fed rats after 2 weeks of treatment. In spontaneously hypertensive rats, MPM-treated animals showed a reduction of SBP by at least 13% (P < .05) for 4 weeks. Results from this study suggest that MPM is a functional ingredient with beneficial effects on lipid metabolism, blood glucose control, and hypertension that might contribute to the management of MetS and thus reducing the risk of cardiovascular diseases.

Glucose Metabolism in Overweight Hispanic Adolescents With and Without Polycystic Ovary Syndrome

About one third of overweight women with polycystic ovary syndrome (PCOS) have either impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM) by the age of 30. We sought to determine if overweight Hispanic adolescents with PCOS are more likely to be insulin resistant and glucose intolerant than those without PCOS. A retrospective chart review of 101 subjects with PCOS and 40 without PCOS was conducted. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI), and fasting glucose/insulin ratio (FGIR) values were calculated by using fasting glucose and insulin levels. Insulin resistance (IR) was defined as a fasting insulin level of >15 microU/mL, a 2-hour insulin level of >75 microU/mL, a HOMA-IR value of >3.16, a QUICKI value of <0.357, and/or a FGIR value of <7. Of the 101 overweight subjects with PCOS (BMI: 33.2 +/- 5.9 kg/m(2)), 4 had IGT and 2 had DM versus none of the 40 subjects without PCOS (BMI: 32.4 +/- 5.3 kg/m(2)). IR was more frequent in the overweight PCOS than in the overweight non-PCOS group (QUICKI: 68.4% vs 14.3%, P = .014) and FGIR (47.4% vs 0%, P = .024). Of the 6 subjects with glucose intolerance, only the QUICKI value was abnormal in all. This retrospective study demonstrated that overweight Hispanic adolescents with PCOS had more IR, IGT and DM than their non-PCOS counterparts. As the QUICKI Index was abnormal in all subjects with IGT and DM, we suggest its use as the first step in deciding which overweight Hispanic adolescents with PCOS should be further tested with an OGTT.

Increased carotid intima-media thickness in pre-pubertal children with constitutional leanness and severe obesity: the speculative role of insulin sensitivity, oxidant status, and chronic inflammation

In order to characterize whether different degrees of adipose tissue storage may be associated with markers of early atherosclerosis, we evaluated oxidant-antioxidant status and inflammatory markers and determined carotid intima-media thickness (cIMT) in healthy constitutional lean and obese pre-pubertal children. Eighty healthy pre-pubertal lean and obese children were recruited and compared with 40 age, gender, and pubertal stage-matched normal controls. Anthropometric measurements, oxidant (urinary isoprostanes (PGF-2alpha), lag phase, and malondialdehyde (MDA)) and antioxidant status (vitamin E), inflammatory markers (high sensitive C-reactive protein (hs-CRP)), and insulin sensitivity (fasting glucose-insulin ratio, homeostasis model assessment of insulin resistance (HOMA-IR)) were investigated. Furthermore, cIMT was measured by high-resolution ultrasound. hs-CRP was not different between lean and control subjects (P=0.45), while higher values were found in obese compared with lean and control children (P<0.001 and P<0.001 respectively). PGF-2alpha and MDA were higher while lag phase shorter in lean and obese subjects compared with controls (lean P<0.001; P<0.001; P<0.001 and obese P<0.001; P<0.001; P<0.001 respectively), while no differences were documented between lean and obese subjects (P=0.78, P=0.019, and P=0.53 respectively). Compared with controls, cIMT was increased in lean and in obese subjects (P=0.001; P=0.004), while no differences were documented between obese and lean subjects (P=0.1). In a multiple stepwise linear regression analysis, cIMT was related with PGF-2alpha (beta=0.641, P<0.001) and HOMA-IR (beta=0.307; P<0.001). Pre-pubertal lean and obese children present increased oxidative stress and impaired inflammation and insulin sensitivity, which in turn seem to result in similar impaired endothelial dysfunction and early signs of atherosclerosis, already in childhood.

Family history of premature cardiovascular disease as a sole and independent risk factor for increased carotid intima–media thickness

The aim of this study was to evaluate carotid intima-media thickness (cIMT) in children with a positive family history of premature cardiovascular disease (PFHPCD) and the relationship between cIMT and other known risk factors (insulin resistance, oxidant status and lipid profile) involved in structural vascular changes. Anthropometric measurements and inflammatory markers [isoprostanes (prostaglandin F-2alpha)] were evaluated in 24 prepubertal children (10 boys, 14 girls, mean age 7.9 +/- 2.37 years) with PFHPCD and compared with 25 healthy prepubertal children (11 boys, 14 girls). Fasting insulin and glycemia levels were evaluated and homeostasis model assessment of insulin resistance and fasting glucose-insulin ratio were calculated in all children. High-resolution ultrasound technique was used to evaluate cIMT. Children with PFHPCD had an increased cIMT (P = 0.001) in comparison with healthy controls. No significant differences were found in terms of fasting insulin levels (P = 0.416), glucose-insulin ratio (P = 0.454) and homeostasis model assessment of insulin resistance (P = 0.317) between children with PFHPCD and controls. Prostaglandin F-2alpha levels were significantly higher in children with PFHPCD than in controls (P = 0.003). In order to evaluate the relationship between cIMT and other known risk factors, a multiple linear regression analysis was performed. A direct correlation was found between cIMT and prostaglandin F-2alpha (beta = 0.905; P = 0.002; r2, 0.63) even after adjusting for confounding factors (age, sex, BMI). Signs of precocious cardiovascular risk are detectable in children with PFHPCD already during prepuberty. Furthermore, impaired oxidant-antioxidant status would be implicated in the detected abnormalities of the vascular wall, suggesting a pivotal role of hereditary and genetic predisposition in the pathogenesis of increased cIMT.

Insulin Resistance in Women with Recurrent Spontaneous Miscarriage of Unknown Aetiology

Objective: The objective of this study was to explore the role of insulin resistance in women with recurrent spontaneous miscarriage (RSM). Patients with ≧3 consecutive spontaneous miscarriages were classified as having RSM. Subjects and Methods: Thirty-five non-pregnant women presenting with RSM in our specialized RSM clinic constituted the study population, while 30 non-pregnant, parous, fertile women without RSM served as controls. The study and control patients were matched for age, ethnicity and body mass index (BMI). Blood was extracted from these patients for fasting blood glucose and fasting insulin simultaneously, and a battery of investigations including ultrasonography was performed on all the patients with RSM. Results: There was no significant difference in the mean fasting glucose for the study and control patients (5.5 ± 0.7 vs. 5.3 ± 0.6 mmol/dl) and in the mean fasting insulin (15.0 ± 5.1 and 12.9 ± 2.9 mU/l). There was a significant difference between the mean parity of the study and control patients (0.7 ± 0.7 vs. 1.7 ± 0.5, p < 0.0001) and also the mean number of miscarriages (4.2 ± 1.2 vs. 0.1 ± 0.4, p < 0.0001). There was, however, no significant difference in the insulin resistance of both groups as calculated using the Homeostasis Model Assessment and the fasting glucose insulin ratio of <4.5. Conclusion: Insulin resistance was not significantly associated with RSM in our study. Further studies may be needed.