Non-metabolic Patients Research Articles

Role of NAFLD-associated genetic variants on renal function in patients with nonalcoholic fatty liver disease

Background and Aims : NAFLD is associated with an increased risk of chronic kidney disease (CKD). Also, recent observations focused the attention on the role of PNPLA3 rs738409 variant in the relationship between NAFLD and CKD in non-metabolic patients, but the genetic impact on this association is still matter of debate. We aim to investigate the potential influence of PNPLA3, TM6SF2, MBOAT7 and GCKR gene variants on renal function in a large population of NAFLD patients.

The Inherent Value of Preoperative Optimization-Absolute and Incremental Reduction in Components of Metabolic Syndrome Can Enhance Recovery and Minimize Perioperative Burden.

Metabolic syndrome (MetS) is an amalgamation of medical disorders that ultimately increase patient complications. Factors such as obesity, hypertension, dyslipidemia, and diabetes are associated with this disease complex. To assess the incremental value of improving MetS in relation to clinical outcomes. Retrospective cohort study. Patients undergoing elective spine surgery were isolated and separated into 2 groups: MetS patients (>2 metabolic variables: hypertension, diabetes, obesity, and triglycerides) and nonmetabolic patients (<2 metabolic variables). T tests and χ 2 tests compared differences in patient demographics. Resolution of metabolic factors was incrementally analyzed for their effect on perioperative complications through utilization of logistic regressions. A total of 2,855,517 elective spine patients were included. Of them, 20.1% had MeTS (81.4% two factors, 18.4% three factors, 0.2% four factors). MetS patients were older, less female, and more comorbid (P < 0.001). About 28.8% MetS patients developed more complications such as anemia (9.8% vs 5.9%), device related (3.5% vs 2.9%), neurologic (2.3% vs 1.4%), and bowel issues (9.7% vs 6.8 %; P < 0.05). Controlling for age and procedure invasiveness, having 3 MetS factors increased a patient's likelihood (0.89×) of developing a perioperative complication (P < 0.05), whereas 2 factors had lower odds (0.82). More specifically, patients who were diabetes, obese, and had hypertension had the greatest odds at developing a complication (0.58 [0.58-0.57]) followed by those who had concomitant hypertension, high triglycerides, and were obese (0.55 [0.63-0.48]; all P < 0.001). MetS patients with 2 factors, being obese and having hypertension produced the lowest odds at developing a complication (0.5 [0.61-0.43]; P < 0.001). These MetS patients also had a lower length of stay than those with 3 and 4 (P < 0.001). Metabolic patients improved in perioperative complications incrementally, demonstrating the utility of efforts to mitigate burden of MetS even if not completely abolished. This review contributes to the assessment of MetS optimization in the field of adult spine surgery.

Metabolic syndrome and psoriasis severity in South-East Asian patients: An investigation of potential association using current and chronological assessments.

Although studies regarding prevalence of metabolic syndrome (MS) in Asian psoriatic patients are limited and show varying results, a previous report describes a significant increase in prevalence of MS in Thai psoriatic patients, as compared with rates in the general population. However, no significant association between MS and psoriasis severity using the Psoriasis Area and Severity Index (PASI) was found, which differs from the findings of Korean and Japanese studies. This study aimed at re-evaluating the association between MS and psoriasis severity in Thai patients using current assessment (PASI) and chronological assessment (historical course and interventions). A total of 273 psoriatic patients were recruited. After controlling for age and sex, 96 patients were assigned to the MS group and 96 patients to the non-MS group. Similar to the previous study, no significant differences were identified between metabolic and non-metabolic patients regarding PASI, age of onset, disease duration and family history of psoriasis. However, the numbers of hospitalizations (P=0.018) and interventions (P=0.028) were significantly higher in metabolic patients than in non-metabolic patients. Further, a greater number of metabolic components was significantly associated with a higher number of hospitalizations (P=0.012), pustular or erythrodermic psoriasis episodes (P=0.049), and interventions (P=0.005). Body mass index of 23kg/m2 or more, abdominal obesity and high blood pressure were associated with an increased risk of treatment failure. Using chronological assessment, our study supported that MS negatively affects psoriasis severity and treatment outcomes. Screening for MS is highly recommended for psoriatic patients.

Metabolic syndrome and coronary artery disease in young Egyptians presenting with acute coronary syndrome

Rationale The aim of this study is to determine the relationship between metabolic syndrome and the extent of coronary artery disease (CAD) in young adults presenting with acute coronary syndrome. Background Metabolic syndrome is associated with subsequent development of type II diabetes mellitus and cardiovascular disease. Individuals with metabolic syndrome are at a higher risk of developing myocardial infarction and CAD. Patients and methods This study was carried out at Kasr Al Ainy Hospital at Cairo University and the Sohag Specialized Cardiac and Digestive System Center. One hundred and twenty-two patients presented with acute coronary syndrome during the period of the study from January 2011 to January 2012. Eighty-five were men (69.7%) and 37 were women (30.3%). Patients were classified into two groups according to the presence or absence of metabolic syndrome to determine the effect of metabolic syndrome on severity of coronary lesions in comparison with nonmetabolic patients. Correlation was assessed between the number of metabolic risk components and coronary lesion severity using the SYNTAX score. Results The metabolic risk score was determined; patients with a significant metabolic score of at least 3 risk score constituted 66.4% of the total cohort (n = 81 patients). Patients were subjected to coronary angiography. Totally occluded vessels were found in 33.3% of metabolic syndrome patients and in 26.8% of non metabolic syndrome patients (P Conclusion Patients with metabolic syndrome have more severe CADs. Preventive measures against metabolic syndrome and its components are very important and could help avoid the large economic burden of secondary prevention.

Effect of metabolic syndrome on perioperative outcomes after liver surgery: A National Surgical Quality Improvement Program (NSQIP) analysis

The problem of obesity has risen to epidemic levels in the United States. A subset of patients with obesity will have metabolic syndrome. We sought to examine the impact of metabolic syndrome on the risk of morbidity and mortality among a large cohort of patients who underwent hepatic resection. Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent hepatic resection between January 2005 and December 2008 were identified. Data on clinical characteristics, comorbidities, operative details, as well as postoperative complications and mortality were collected and analyzed. Patients with BMI >30 kg/m(2) who also had hypertension and diabetes were defined as having metabolic syndrome. A total of 3,973 patients who underwent a liver resection were identified. Overall mean body mass index was 28 kg/m(2); 31.7% patients were obese (>30 kg/m(2)). Of the patients who were obese, 256 (20%) had metabolic syndrome. Patients with metabolic syndrome were less likely to have had a major hepatectomy (≥hemi-hepatectomy, 36% vs 43%; P = .01) but had a greater mean number of red blood cell transfusions (1.6 vs 1; P=.02). The incidence of postoperative complications after hepatectomy was 23%. Patients with metabolic syndrome had a greater risk for reintubation (odds ratio [OR] 1.9; P=.02), >48 hours ventilator dependence (OR 2.0; P = .003), myocardial infarction (OR 5.5; P=.01) and superficial surgical-site infections (OR 1.7; P=.02) compared with nonmetabolic patients. Overall postoperative mortality was 3%. Metabolic syndrome was associated with an increased risk of postoperative death (OR 2.7; P = .001). The presence of metabolic syndrome was associated with a greater risk of perioperative complications. In addition, patients with metabolic syndrome had greater than a 2-fold increased risk of death after hepatic resection.