Risk Of Metabolic Disturbances Research Articles

What is the true nature of the relationship between metabolic disturbance, specifically of glucose and insulin metabolism, and depressive and other mood disorders?

Much attention in recent years has focused on the extent to which the risk of metabolic disturbances, and most fundamentally of glucose and insulin, are prevalent among those treated for depressive and other mood disorders (Osimo et al., 2021; Scott et al., 2019; Tickell et al., 2022). Public concern has also focused on the increased rates of premature mortality in those with chronic depression and other major mental disorders, with a significant proportion of that risk being due to early-onset cardiovascular disease (particularly among women). A common assumption is that much of this risk is a consequence of medical treatments for depression, and their possible adverse effects such as increased risk of diabetes, presumably mediated by long-term weight gain.

Impact of Nutrition on Telomere Health: Systematic Review of Observational Cohort Studies and Randomized Clinical Trials

Diet, physical activity, and other lifestyle factors have been implicated in the pathophysiology of several chronic diseases, but also in a lower total mortality and longer life expectancy. One of the mechanisms in which diet can reduce the risk of disease is with regard to its impact on telomeres. Telomere length (TL) is highly correlated to chronological age and metabolic status. Individuals with shorter telomeres are at higher risk of chronic diseases and mortality. Diet may influence TL by several mechanisms such as regulating oxidative stress and inflammation or modulating epigenetic reactions. The present systematic review aims to examine the results from epidemiologic and clinical trials conducted in humans evaluating the role of nutrients, food groups, and dietary patterns on TL. We also discuss the possible mechanisms of action that influence this process, with the perspective that TL could be a novel biomarker indicating the risk of metabolic disturbances and age-related diseases. The available evidence suggests that some antioxidant nutrients, the consumption of fruits and vegetables, and Mediterranean diet are mainly associated with longer telomeres. However, most of the evidence is based on high heterogenic observational studies and very few randomized clinical trials (RCTs). Therefore, the associations summarized in the present review need to be confirmed with larger prospective cohort studies and better-designed RCTs.

Síndrome de ovario poliquístico: fenotipos y enfermedad cardiovascular

IntroductionPolycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. It is associated with insulin resistance (IR) and high cardiovascular risk (CVR). According to the Rotterdam consensus, four PCOS phenotypes could be established: three with clinical and/or biochemical hyperandrogenism (HA), and one non-hyperandrogenic (NHA). It is necessary to identify which of these patients are at risk of metabolic disturbances and CVR. Two indexes: lipid accumulation product (LAP) and visceral adiposity index (VAI) have been suggested as reliable markers of IR and CVR in PCOS. ObjectiveThe present study aims to assess the reliability of LAP and VAI as IR markers in a young local population of PCOS patients. Their association with CVR parameters is also evaluated. MethodologyLAP and VAI were calculated in 130 PCOS patients. The PCOS patients were divided in two groups as HA and NHA, taking into account the signs of hyperandrogenism (clinical or biochemical). An evaluation was also made of the metabolic and anthropometric characteristics of the population and their association with CVR and IR. ResultsBoth LAP and VAI showed to be effective markers to asses CVR and IR in these PCOS women (cutoff values: LAP: 14.02 (sensitivity: 93.94% specificity: 93.22%) VAI: 2.17 (sensitivity: 87.88% specificity: 91.38%). There was a positive correlation of both markers with abdominal circumference and triglycerides (TG), and negative with HDL-cholesterol. The risk of IR and metabolic disturbances was similar in both phenotypes (NHA versus HA). ConclusionOur data show that both LAP and VAI are representative markers for assessing IR and associated CVR in PCOS patients. These results also suggest that the NHA phenotype in the population studied shows the same risk of metabolic disturbances and cardiovascular disease when compared to HA phenotypes.

Adipokines and a risk for metabolic disturbances in different types of female obesity

To investigate the effects of adiponectin and leptin on the development of metabolic disturbances in women with android and gynoid fat distribution. A total of 101 women aged 40 to 65 years were examined. Anthropometric measurements were made; overweight and obese women with a waist/hip (W/H) ratio of less than 0.83 were referred to as a gynoid fat distribution (GFD) group; and those with a W/H ratio of 0.83 or more were to an android fat distribution (AFD) group. The serum concentrations of triglycerides, high-density lipoprotein cholesterol, and glucose were measured; the levels of insulin, leptin, and adiponectin were determined by enzyme immunoassay. Insulin resistance (IR), HOMA IR, and visceral obesity index (VOI) were calculated. With the same excess adipose tissue accumulation, the women with GFD had a less magnitude of hormonal and metabolic disturbances than those with AFD, whose HOMA-IR also pointed to the presence of IR. VOI was insignificantly higher in the women with GFD and 2.4-fold greater than that in normal weight (NW) women. In the women with GFD and AFD, the concentration of leptin was higher than that in the NW women, which was characteristic of obesity, but the concentration of adiponectin proved to be significantly lower in the patients with AFD and to be unchanged in those with GFD as compared with that in the NW women. The women with AFD are typified by a high VOI, hypoadiponectinemia, IR, and metabolic disturbances, which determine a high risk for cardiovascular events and type 2 diabetes mellitus. In the women with GFD, obesity is associated with normal adiponectinemia and a low VOI and, in terms of hormonal and metabolic characteristics, may be characterized as metabolically healthy obesity.

Nonalcoholic Fatty Liver Disease (NAFLD) after Liver Transplantation: A Mini-Review

Nonalcoholic Fatty Liver Disease (NAFLD) after Liver Transplantation: A Mini-Review Nonalcoholic fatty liver disease (NAFLD) encompasses a large spectrum of disease including simple steatosis, nonalcoholic steatohepatitis (NASH) and in some patients liver fibrosis, cirrhosis, liver failure and hepatocellular carcinoma. In the last few years NAFLD has became the most common liver disease in Western countries and has been recognized an important indication for the liver transplantation as well. Advances in medical therapy and surgical techniques have transformed the long-term survival of liver-transplant (LT) recipients. Currently metabolic syndrome and NAFLD recurrence or de novo NAFLD are common among LT NAFLD recipients since they present an increased risk of metabolic disturbances as a natural result of their personal characteristics.

Antiischemic effects of metoprolol and the risk of carbohydrate metabolism disturbances in angina patients

Aim. To study the association between antiischemic effects (AIE) of metoprolol (MP), glucose tolerance, and insulin sensitivity in patients with stable angina (SA). Material and methods. The study included 28 male patients, aged 46-68 years, with stable effort angina, Functional Class II-III, and positive exercise stress test (EST). The time of the ST segment depression by ≥1 mm defined the threshold exercise stress time. MP in a selected dose was administered twice a day, for one month. Its hemodynamic effects were assessed by the dynamics of heart rate (HR), blood pressure (BP), and double product (DP). Glucose tolerance test (GTT) was performed at baseline (before MP administration) and after one month of MP treatment. Tissue insulin sensitivity and insulin resistance (IR) were assessed by ISI0.120 and HOMA-IR parameters, respectively. Results. AIE was registered in 57% of the patients, while 43% failed to demonstrate it. Both groups did not differ by the extent of MP impact on the levels of HR, BP, and DP. The presence or absence of AIE was linked to selected parameters of glucose metabolism. In patients with AIE, the pre-treatment levels of glucose and insulin 2 hours after glucose load were higher (p=0,028 and 0,043, respectively) and ISI1,120 values lower than in patients without AIE (p=0,023). Among participants with AIE, impaired glucose tolerance (IGT) was observed in 4 at baseline and in 8 one month later; among patients without AIE, IGT was not registered. Conclusion. For the first time, the presence of AIE during MP therapy of SA patients was linked to the decreased insulin sensitivity of peripheral tissues (ISI0.120). Paired EST with a single MP dose at baseline provides an opportunity to identify the patients with a higher risk of metabolic disturbances during the longer-term MP treatment.

The incidence of abdominal obesity and the associated metabolic disturbances in the children aged 7-13 years

Stage 1 of the present study was designed to estimate the incidence of abdominal obesity among 878 schoolchildren aged between 7 and 13 years using the percentile tables for the waist circumference (WC) in the children's population of the United Kingdom and from the WC/height ratio that makes it possible to identify children at the highest risk of metabolic disturbances. The incidence of abdominal obesity based on the criterion of WC≤90th percentile (PC) for the age and the sex was estimated to be 33.1% for the entire group in the absence of significant difference between boys and girls (30.7% vs 35,5%). The incidence of abdominal obesity based on the criterion of WC/height ratio with a threshold value of ≤0.5 was 9.9% for both sexes in the entire group; it was significantly higher in the boys than in the girls (13.1% vs 6.9%). At the second stage of the study, the group of the children having WC≤90th percentile (n=51) showed significantly higher systolic and diastolic arterial pressure, blood triglyceride and insulin levels and HOMAIR index but lower HDL levels than control patients with WC < 90th percentile (n=28). The results of the study suggest the high incidence of abdominal obesity among young schoolchildren residing in large cities. Moreover, such children tend to develop metabolic disturbances and are at risk of cardiovascular diseases.

Family History of Diabetes and Parental Consanguinity: Important risk for Impaired Fasting Glucose

Abstract Objective: Offspring of type 2 diabetics have incre-ased risk of metabolic disturbances. The aim of the study was to access the potential effect of family his-tory of type 2 diabetes (FHD) and parental consangui-nity on fasting plasma glucose (FPG) levels. Design: Non diabetic offspring of one or both parents with type 2 diabetes and healthy controls of compar-able age, without a FHD were the subjects of this stu-dy. FHD was defined by the presence of type 2 diabe-tes in one or both parents of the subject. Consanguinity was defined as history of marriage with first cousin. FPG levels were determined in cases and controls. Results: IFG was identified in 42% subjects with a FHD and in 14% without FHD. We found a strong in-dependent association of FHD with impaired fasting glucose in both males and females by logistic regres-sion analysis after adjusting the data for age sex and BMI. Parental consanguinity modifies the effect of FHD on IFG. Conclusion: We concluded that family history of dia-betes and parental history of consanguinity determine the risk for impaired fasting glucose in our population. Keywords: Impaired fasting glucose; Parental con-sanguinity; Family history of diabetes.

Syndrome of hyperandrogenism in girls of pubertal age

Syndrome of hyperandrogenism in women is one of the commonest disease of the adult age. It is associated with a high risk of metabolic disturbances, cardiovascular disorders, and infertility. Taken together, these factors dictate the necessity of in-depth investigations of this pathology. At present, both etiology and pathogenesis of the syndrome of hyperandrogenism remain obscure. As a rule, its clinical manifestations become apparent at puberty. The present review summarizes the data on the development and clinical course of female hyperandrogenism with special reference to its occurrence, diagnostic tools, and therapeutic modalities in adolescent girls.

Acid-Base Balance after Continent Urinary Diversion in Childhood – Risk of Imbalance Despite Medication

Purpose Continent urinary-intestinal diversion can lead to alterations of the acid-base balance, acutely and chronically, the latter possibly causing bone demineralization. Annual check-ups have therefore been recommended for decades. Material and Methods At our institution, 89 children underwent continent urinary diversion by ileocecal pouch or bladder substitution between 1984 and 2006. In 58 of these patients (age 3-17 y., median 13.9 y.), we performed a minimum of 3 (range 3-23, median 6.2) consecutive annual blood-gas analyses over a follow-up period of up to 23 years (median 11.0) after surgery. At a base excess (BE) (as marker of the acid-base-balance) value below -2.5 mmol/l, treatment was initiated. Results Of 58 patients, 17 (29%) constantly presented BE values above -2,5 mmol/l and therefore remained without medication. The majority of patients (n=41, 71%) was in need of continuous alkali supplementation. The BE values of the untreated patients showed a mild undulation within 2,5 and - 2,5 mmol/l over the years, whereas those under medication often presented peaks and troughs between 8 and -10 mmol/l. In those patients the medication was adjusted. Conclusions After continent urinary diversion by ileocecal pouch/bladder substitution in childhood, permanent alkali supplementation is necessary in the majority of the cases (71%). Those undergoing medication appear to be at greater risk for metabolic disturbances despite treatment. Therefore this group might carry a greater risk for later bone demineralization, and therefore needs a more frequent surveillance and adjustment of medication than previously thought.

Diagnóstico etiológico do hirsutismo e implicações para o tratamento

Hirsutism may be defined as the presence of terminal hair in the women, with a male pattern of distribution. The clinical presentation is variable, from isolated hirsutism to the presence of other signs of hyperandrogenism, menstrual irregularities and/or infertility. Hirsutism is related to serum androgens and to the cutaneous sensitivity to these hormones. The most prevalent causes of hirsutism are polycystic ovary syndrome and isolated hirsutism, in the presence of ovulatory cycles. Non-classical congenital adrenal hyperplasia (21-hydroxylase deficiency) and drug-induced hirsutism are less frequent causes. Androgen-secreting neoplasms and Cushing syndrome are rare etiologies related to hirsutism. Diagnostic evaluation should address on identifying the etiology and potential risk for associated comorbidities. The aims of the treatment are: to suppress androgen overproduction, if present; to block androgen action on hair follicles; to identify and treat patients at risk for metabolic disturbances or reproductive neoplasias.

Association between antipsychotics and weight gain among psychiatric outpatients in Pakistan: a retrospective cohort study

BackgroundIt has been known for a long time that use of antipsychotics, particularly atypical antipsychotics, is associated with weight gain and increase in risk of metabolic disturbances. In this study we have tried to find out if use of antipsychotics is associated with increase in weight and body mass index (BMI) in the Pakistani population.MethodsWe performed a case note review of all patients who had been prescribed antipsychotic medication at the psychiatry outpatient clinic of a tertiary care university hospital in Pakistan over a 4-year period.ResultsA total of 50% of patients had a BMI in the overweight or higher range at baseline. Patients showed a mean weight gain of 1.88 kg from baseline in 3 months and 3.29 kg in 6 months. Both of these values were statistically significant. The increase in mean BMI from baseline was 0.74 and 1.3 in 3 months and 6 months, respectively. In patients for whom we had at least one further weight measurement after baseline, 48% (39/81) showed a clinically significant weight gain.ConclusionPakistani patients are just as likely to put on weight during antipsychotic treatment as patients from other countries. Considering that this population already has a much higher prevalence of diabetes mellitus compared to the Western countries, the consequences of increased weight may be even more serious in terms of increased morbidity and mortality.

Schizophrenia Host Vulnerability and Risk of Metabolic Disturbances During Treatment with Antipsychotics

People with schizophrenia die prematurely from comorbid physical diseases, particularly from cardiometabolic disturbances. Although some host vulnerability exists, there is also mounting evidence of a relationship between metabolic disturbances and antipsychotic medications. Clinicians must now make a careful appraisal of these risks when choosing an antipsychotic drug. Additionally, clinicians are required to undertake close monitoring for metabolic disturbances during antipsychotic therapy. Although switching antipsychotic medications is currently the preferred strategy if metabolic disturbances occur, there are other pharmacologic and nonpharmacologic approaches that might also prove beneficial for the individual patient. Metabolic disturbance and the detection and management thereof currently hold “center stage” in the psychopharmacology of schizophrenia.

Metabolic complications of obesity in childhood and adolescence: more than just diabetes

The alarming increase in the prevalence of pediatric obesity has led to a rise in associated metabolic complications in worldwide pediatric populations. This review summarizes recent literature on detection, pathophysiology, and potential intervention strategies for the metabolic derangements encountered in the overweight pediatric population. Development of metabolic complications associated with obesity during childhood track into adulthood and increase the risk for type 2 diabetes and early cardiovascular disease. Clustering of these metabolic abnormalities, which include insulin resistance, hypertension and dyslipidemia, constitutes the metabolic syndrome, which may affect up to 50% of overweight adolescents. Other serious disorders associated with obesity and insulin resistance include polycystic ovary disease and fatty liver. Family and school-based programs focusing on lifestyle modifications, as well as pharmacotherapy, have shown preliminary promise in reversing some of these derangements. As the trend in pediatric obesity continues to rise, providers must effectively identify children at risk for metabolic disturbances and implement long-lasting, successful treatment regimens. Continued research into the predecessors of cardiovascular disease that begin during childhood and how they can be altered is crucial to the future health of our pediatric population.

Atypische Neuroleptika und metabolisches Syndrom

The introduction of atypical antipsychotics in psychopharmacology represented a major advance in the treatment of psychotic disorders. However, there have been numerous studies that certain atypical antipsychotics may be associated with a greater risk of metabolic abnormalities than others, including weight gain, hyperlipidemia and new-onset typ 2 diabetes mellitus. A G-Protein beta3 subunit Gen (C825T) polymorphism, an increased carbohydrate metabolism and dyshormonism are discussed as pathogenetic mechanisms. High risk patients (adiposity, hyperlipidaemia, hyperglycaemia, preexisting diabetes) should maintain an antipsychotic agent with a favourable side effect profile. In these cases a periodical diabetes screening and blood lipid controls are required. Clinicans must balance the significant benefits of atypical antipsychotics against the risk of metabolic disturbances. In this article recent findings are reviewed.

Epidemiological impact of antidepressant and antipsychotic drugs on the general population

To analyse the prevalence of and sex and age distribution associated with antidepressant and antipsychotic drug exposure in the general population and to highlight recent epidemiological findings concerning specific adverse outcomes associated with drug exposure. Epidemiological studies indicate high rates of second-generation antidepressant and antipsychotic drug use in the general population. The use is more prevalent among women than among men, and in older rather than in younger age groups. A new pattern of adverse outcomes has been described in individuals exposed to newer agents, including a possible risk of suicidal acts in adults receiving second-generation antidepressants, the risk of cerebrovascular events in older individuals receiving second-generation antipsychotics and the risk of metabolic disturbances in individuals exposed to specific second-generation antipsychotics. The assessment of, and attention to, the development of specific adverse reactions in individuals exposed to second-generation psychotropic drugs may improve treatment outcomes.

Standing the test of time: long-term outcome of reconstruction of the exstrophy bladder

The surgical management of classic bladder exstrophy has evolved over time. Different techniques are used to address the challenge of reconstructing these patients. We review the long-term outcomes of bladder exstrophy treatment from the published literature with regard to urinary continence, voiding and secondary complications. Continence now can be achieved in up to 80% of children in specialist centres. Whether such success can sustained into adult life is uncertain. About 40% of adults are dry in the best hands. Up to 84% of children can void, but there is some evidence that this function is lost with time in 70%. The need for bladder augmentation is widely variable between series, reported in 0-70% of children. This reduces the ability to void spontaneously to about 50% of children. It brings with it the later risk of metabolic disturbance and stone formation. Adults with exstrophy have a 694-fold increase in the risk of bladder cancer by the age of 40 years.

The Atypical Antipsychotic Therapy and Metabolic Issues National Survey: practice patterns and knowledge of psychiatrists.

A nationwide survey in 2003 of 300 randomly selected psychiatrists who routinely treat schizophrenia with atypical antipsychotic therapy was conducted to ascertain practice patterns and attitudes regarding metabolic disturbances during atypical antipsychotic therapy with an emphasis on how these perceptions impact therapeutic decision making. Psychiatrists generally believe that some atypical antipsychotic drugs are associated with metabolic disturbances and that atypical antipsychotics differ in their risk for metabolic disturbances. A majority of respondents (82%) believed that patients with schizophrenia-even those not receiving atypical antipsychotic therapy-are at greater risk for metabolic abnormalities than the general population. A majority of respondents recognized weight gain and diabetes mellitus (59% and 51%, respectively) as potential metabolic complications of atypical antipsychotic therapy, while only some recognized dyslipidemia and certain acute metabolic decompensations like diabetic ketoacidosis (22% and 2%, respectively). Large minorities of respondents (48% and 43%) indicated a willingness to risk weight gain and/or diabetes for the benefits of atypical antipsychotics, possibly because metabolic issues were regarded as long-term issues. However, large majorities also stated that they considered metabolic issues when selecting atypical antipsychotic therapy for some or all of their patients (90%), and that emergence of metabolic dysfunction prompted them to change atypical antipsychotic treatment regimens (85%). Additional efforts at continuing education and communication regarding metabolic outcomes associated with atypical antipsychotic therapy, as well as critical reviews in this area, may help clarify atypical antipsychotic treatment risks and benefits. The results from the survey indicate that psychiatrists are aware of and concerned about metabolic risks and how they differ across the atypical antipsychotic class. The impact of additional data and educational efforts in this area, such as a recently published consensus statement from the American Diabetes Association and other organizations, remains to be assessed.