Homeostatic Model Assessment Score Research Articles

The metabolic risk profile of breast cancer survivors 2 to 6 months post-chemotherapy.

e19612 Background: Overweight and obesity are associated with poor outcomes for patients with breast cancer. Physical inactivity coupled with weight gain during treatment place breast cancer survivors at risk of developing obesity related problems including the metabolic syndrome (MetSyn). We report baseline findings of an ancillary study to an ongoing randomised controlled trial (PEACH trial) (Walsh J.M. et al. 2010 Pragmatic Randomized Trial of Individually Prescribed Exercise versus Usual Care in Heterogeneous Cancer Survivor Population. A Feasibility Study. PEACH: Prescribed Exercise After Chemotherapy. BMC Cancer. 10[42]) examining the effect of exercise on the metabolic risk profile of breast cancer survivors, 2-6 months post chemotherapy. Methods: Breast cancer survivors who consented to partake in the PEACH trial were requested to participate. The five clinical features of the MetSyn were measured: waist circumference, resting blood pressure, triglycerides, high-density lipoprotein cholesterol and fasting glucose, along with a lipid profile and C – Reactive Protein (CRP). Insulin resistance was estimated by the homeostatic model assessment (HOMA) index. Subjects were classified with the MetSyn if they presented with three of the five clinical features. Results: Eighteen subjects (mean (±SD) age 46.17±7.93 years) have completed assessments, 44% were overweight and 28% obese. Four subjects were classified with the MetSyn and a further 7 presented with two clinical features. Fourteen subjects (77.8%) were centrally obese with a mean waist circumference of 87.6±9.89cm. The mean total cholesterol level was 5.37±1.02 mol/L, with 11 subjects (61.1%) presenting with measurements above 5.2mol/L. The mean HOMA score was 1.93±1.16. CRP levels were low at < 10.00mg/L. Conclusions: Results indicate that breast cancer survivors present with an unfavourable metabolic profile in the six months following chemotherapy. The high percentage of subjects presenting with an elevated waist circumference is concerning and may contribute to further development of MetSyn. Interventions to target this problem including diet and exercise are warranted in this population.

Insulin Resistance Is Associated With Advanced Liver Fibrosis and High Body Mass Index in HIV/HCV-Coinfected Patients

Insulin Resistance Is Associated With Advanced Liver Fibrosis and High Body Mass Index in HIV/HCV-Coinfected Patients

Adipokines and cytokines in non‐alcoholic fatty liver disease

Several adipocytokines have been implicated in the pathogenesis non-alcoholic fatty liver disease (NAFLD). To assess adipocytokines in NAFLD patients and controls. A total of 95 patients (26 non-alcoholic steatohepatitis (NASH), 19 simple steatosis (SS), 38 obese controls and 12 non-obese controls) were included. Fasting serum insulin, glucose, visfatin, resistin, adiponectin, tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) and IL-6 were determined. Univariate and multivariate analyses were used to compare groups and determine associations. Serum TNF-alpha and IL-8 were higher in NAFLD patients when compared with both obese and non-obese controls. Analysis involving all patients revealed a significant correlation between serum TNF-alpha and IL-8 (P < 6.319e-08), and between IL-6 and IL-8 (P < 5.271e-15). Homeostatic model assessment scores negatively correlated with adiponectin in NAFLD (P < 0.0032). Serum visfatin was higher in all three obese groups than in non-obese controls (P < 0.02, P < 0.002 and P < 0.008). Visfatin in NASH patients was lower than SS and obese controls. Although TNF-alpha was associated with NAFLD (P < 0.02), it was interdependent on visfatin. In comparison to SS, four factors were independently associated with NASH: age, alanine aminotransferase, IL-8 and adiponectin (P < 0.05). Multivariate analysis indicated that TNF-alpha was the only independent predictor of fibrosis in NASH (P < 0.0004). These findings support a complex interaction between adipocytokines and the pathogenesis of NAFLD.

Epidural Anesthesia and Analgesia Decrease the Postoperative Incidence of Insulin Resistance in Preoperative Insulin-Resistant Subjects Only

Insulin resistance (IR) is a feature of the endocrine stress response to surgery. It is not known whether a preoperative state of IR would affect the postoperative endocrine response. We sought to characterize the preoperative state of IR in a group of patients undergoing elective hip and knee arthroplasty, and to determine to what extent perioperative epidural analgesia modifies the postoperative state of IR in those who are and are not insulin-resistant before surgery. Sixty patients undergoing either hip or knee arthroplasty were screened by using the homeostatic model assessment (HOMA) in two populations: insulin-resistant patients and noninsulin-resistant patients, whereas HOMA is fasting insulin (microU/mL) x fasting glucose (mmol/L)/22.5. The patients belonging to each population were then randomly assigned to receive either intraoperative epidural blockade followed by postoperative epidural analgesia (epidural group) or general anesthesia followed by patient-controlled analgesia (control group). Analgesia was assessed with visual analog scale up to 48 h after surgery and HOMA was repeated at the end of surgery and 48 h after surgery to determine the postoperative state of IR. Epidural anesthesia and analgesia significantly influenced the postoperative HOMA score (smaller proportion of IR) in the postoperative period only in those patients who were insulin-resistant before surgery (P < 0.01). In contrast, noninsulin-resistant patients had a similar postoperative proportion of IR between the epidural and control groups (P > 0.05). At rest and during movement, visual analog scale scores were not different between groups at the end of surgery and in the first and second days after surgery. Epidural anesthesia and analgesia compared to general anesthesia followed by patient-controlled analgesia decreased the incidence of IR soon after surgery and 48 h after surgery only in patients who were insulin-resistant before surgery.

Metabolic disorders in patients with recent gestational diabetes mellitus

To determine metabolic disorders in patients with recent gestational diabetes mellitus (GDM) compared with controls. Thirty-six patients with recent GDM and treated with a diabetic diet only, and 33 controls with normal pregnancies, were included in the study. An oral glucose tolerance test, with corresponding insulin and hormone levels, was performed; the homeostatic model assessment scores were calculated to estimate insulin resistance; prevalence of polycystic ovarian morphology on ultrasound scan was assessed; and results were recorded 10-15 months after delivery. Waist : hip ratio and fasting cholesterol and triglyceride levels were significantly higher in women with recent GDM; high-density lipoprotein cholesterol did not differ between groups. Fasting, 1-h and 2-h plasma glucose levels were significantly higher in the GDM group; no statistically significant difference was found between groups regarding fasting insulin levels, 1-h and 2-h insulin response, and homeostatic model assessment scores. Serum hormone levels did not differ between groups. The prevalence of polycystic ovarian morphology was greater in women with GDM. There was no difference in any metabolic parameter between women in the GDM group with polycystic ovaries and those with normal ovaries. We found a higher prevalence of polycystic ovarian morphology in women with GDM than in controls. Among women with recent GDM, higher waist : hip ratios and fasting plasma glucose and triglyceride levels may indicate metabolic syndrome. In women with recent GDM managed by diet only, insulin resistance may not be detected in the short term.

Failure of the homeostatic model assessment calculation score for detecting metabolic deterioration in young patients with polycystic ovary syndrome

To verify whether the homeostatic model assessment (HOMA) test is a suitable method for the identification of metabolic deterioration in normal-weight patients affected by polycystic ovary syndrome (PCOS). Prospective clinical study. Academic clinic and research environment in Cagliari, Italy. Forty-nine PCOS normal-weight adolescent subjects, and 50 eumenorrheic, normal-weight, nonhirsute controls matched for age and body mass index (BMI). History and physical examination, oral glucose tolerance test (OGTT) and blood sampling, ultrasound. The HOMA score and integrated secretory area under the curve of insulin values (I-AUC) during the OGTT were calculated. Normal insulin sensitivity was defined as upper control 95th percentile by HOMA values <65.6, I-AUC at 180 minutes <16,921, and I-AUC at 120 minutes <11,817. When applying the calculated I-AUC cutoff, 27 PCOS patients were classified as normoinsulinemic and 22 as hyperinsulinemic, whereas using the calculated HOMA cutoff, only 9 PCOS patients could be classified as insulin resistant (IR). Thirteen of the 40 non-IR PCOS patients presented with hyperinsulinemia; fasting glucose and insulin levels and HOMA scores were not sufficient to identify these subjects. Thus, the HOMA test displayed a low sensitivity (41%) and specificity (100%) in the diagnosis of the metabolic disorder disclosed by I-AUC. Moreover, analysis of I-AUC after 120 and 180 minutes revealed how the shorter evaluation period did not suffice for identification of all hyperinsulinemic subjects, implying an unrecognized condition in 11 of 22 subjects. In young, normal-weight patients with PCOS, the prevalence of hyperinsulinemia is not detectable by HOMA studies. The prevalence of IR was 18% according to HOMA evaluation, whereas hyperinsulinemia was found in 44% of subjects examined by I-AUC. Normal-weight, young PCOS patients should undergo a 3-hour OGTT to detect early metabolic abnormalities.

Effect of an acute hyperinsulinaemic clamp on post‐prandial lipaemia in subjects with insulin resistance

Obese, insulin-resistant individuals have raised levels of intestinal and hepatic lipoproteins. Insulin decreases the production of hepatic lipoproteins in vivo and so this study aimed to investigate whether an acute hyperinsulinaemic, euglycaemic clamp could correct fasting and post-prandial dyslipidaemia. In a randomized, cross-over design, post-prandial lipaemia was compared in subjects infused either with insulin to achieve a steady-state concentration of 100 mU L(-1) or with saline. Nine obese (Body Mass Index > 26 kg m(-2); waist : hip > 1.0) insulin-resistant (Homeostatic Model Assessment score > 2.0) male subjects were given an oral fat load 3 h after the infusions began, and sampling continued for 6 h. Plasma apoB-48, triglyceride and nonesterified fatty acid (NEFA) were measured hourly. Average steady-state serum insulin levels during the hyperinsulinaemic clamp were 123 +/- 4.4 mU L(-1). A paired analysis showed no net effect of insulin on post-prandial chylomicron metabolism when calculated as the (apoB-48) incremental area under the curve (IAUC). However, there was a trend towards a delay in the apoB-48 peak, consistent with possible changes in the rates of chylomicron biogenesis, lipolysis and/or clearance. Similarly, post-prandial lipaemia (depicted as triglyceride IAUC) was similar for subjects infused with insulin or saline, but the peak post-prandial response was delayed during insulin infusion. The NEFA were rapidly decreased by 83% after 3 h of insulin infusion. In obesity and insulin resistance, short-term changes in plasma insulin do not appreciably exert a regulatory effect on exogenously-derived post-prandial lipoproteins. The data suggest that hyperchylomicronaemia in insulin-resistant subjects is a result of chronic aberrations in insulin-mediated regulation of post-prandial lipid metabolism.

Metabolic Syndrome Predicts Frailty

SAN FRANCISCO — Elderly individuals who have metabolic syndrome are about twice as likely to become frail as those who are healthy, Dr. Joshua I. Barzilay reported in a poster presentation at the Third World Congress on Insulin Resistance Syndrome. The study involved 2,376 individuals aged 69–74 who were followed prospectively for 7–9 years. At baseline none of the participants were frail, nor did they have other illnesses that increase inflammation markers or mimic frailty, reported Dr. Barzilay, of Emory University, Atlanta, and his colleagues. A participant was considered frail if he or she met at least three of the following five criteria: unintentional weight loss of 10 pounds or more in the previous year, low grip strength, self-reported exhaustion, slowness in walking, and low exercise tolerance. A participant was considered “prefrail” if he or she met one or two of the criteria. At the end of follow-up, 169 participants qualified as frail and another 1,082 qualified as prefrail. The three most commonly seen components of frailty were diminished walking speed, diminished strength, and diminished activity, all of which are consistent with sarcopenia. Participants who developed frailty or prefrailty had significantly higher fasting insulin levels, higher white blood cell counts, higher C-reactive protein levels, and higher factor VII levels than those who didn't develop frailty. These participants were 30%–100% more likely to have metabolic syndrome at baseline, compared with those who did not develop frailty or prefrailty. The most common components of the metabolic syndrome in this cohort were increased girth and increased homeostatic model assessment scores. They were also significantly more likely to have developed diabetes at follow-up. In view of the fact that frailty was defined mostly by sarcopenia, the investigators wrote, insulin resistance, inflammation, and frailty are all related to a primary disorder of muscle metabolism.