Effect of insulin on serum lipids in relation to nutritional status in diabetics

Serum levels of cholesterol, triglyceride, free fatty acid (FFA) and high density lipoprotein (HDL) cholesterol were studied in 10 undernourished and 10 better nourished diabetic patients at different periods of insulin treatment and in non-diabetic controls. Serum concentrations of cholesterol, triglyceride and FFA were significantly higher in untreated diabetic patients than in control but the elevated lipid levels gradually shifted towards normal on insulin treatment. The HDL cholesterol, on the other hand, was significantly lower in untreated diabetic subjects than those in controls and the HDL cholesterol also gradually modified on insulin therapy. However, the improvement of all the lipid parameters on insulin treatment was somewhat delayed in undernourished compared to those of better nourished diabetics. These results, therefore, suggest that malnutrition interferes with the serum lipid improvement in diabetics on insulin treatment and may make them more prone to develop vascular complications.     

Serum Lp(a) in diabetics with and without evidence of clinical nephropathy—A preliminary study

Type 2 diabetes is associated with a marked increase in the risk of coronary artery disease. Dyslipidaemia is believed to be a major cause of this increased risk. Recently, elevated levels of lipoprotein (a), Lp(a), have been reported to be associated with an increased risk. However there is very little data regarding Lp(a) concentrations and type 2 diabetes from India. The objective of the study was to assess serum Lp(a) levels in type 2 diabetics with and with out evidence of clinical nephropathy. We estimated serum Lp(a) levels in 30 control subjects, 30 diabetics without evidence of clinical nephropathy and 30 diabetics with evidence of clinical nephropathy. Statistical analysis showed that Lp(a) levels were increased in diabetic patients with nephropathy (mean 46.3±17.6 mg/dl). The Lp(a) levels however did not differ significantly between control (mean 20.2±15.9 mg/dl) and diabetics without nephropathy (mean 22.6±13.1mg/dl). Thus diabetes per se seems to have little or no influence on serum Lp(a) levels, however elevated levels were seen in patients with nephropathy.     

Association of Type II 5′ Monodeiodinase Thr92Ala Single Nucleotide Gene Polymorphism and Circulating Thyroid Hormones Among Type 2 Diabetes Mellitus Patients

Diabetes mellitus and thyroid disorders are common endocrinopathies, which often occur parallel. Dyslipidemia is very common in both of these conditions. The development of hypothyroidism is well-known in type 1 diabetics, but it was not distinctly understood in type 2 diabetics. Thus we tried to examine the association between type II deiodinase (D2 or DIO2) Thr92Ala single nucleotide gene polymorphism and thyroid function among type 2 diabetes mellitus patients. A total of 130 type 2 diabetics were screened and genotyped for DIO2 Thr92Ala polymorphism. Fasting plasma glucose, Glycosylated haemoglobin, lipid and thyroid profiles, malondialdehyde (MDA) and paraoxonase were estimated according to standard procedures. A significant altered level of thyroid hormones (TH’s) was found in Ala/Ala genotype when compared with Thr/Thr or Thr/Ala genotype. DIO2 and T₃:T₄ ratio significantly decreased, whereas total T₄ and thyroid stimulating hormone levels significantly elevated among Ala/Ala genotype (131 ± 30 ng/ml; 0.12 ± 0.05; 7.17 ± 2.05 µg/dl; 4.77 ± 3.1 µIU/ml, respectively) when compared with Thr/Thr + Thr/Ala genotypes (176 ± 33 ng/ml; 0.21 ± 0.05; 5.21 ± 1.1 µg/dl; 2.59 ± 1.61 µIU/ml respectively). Moreover, D2 levels were significantly negatively correlated with TH’s levels except total T₄ among Ala/Ala genotypes. All the patients were having a poor glycemic control, and their glycemic status was positively correlating with MDA levels. On the other hand, serum paraoxonase activity decreased among Ala/Ala genotype (104 ± 21 vs. 118 ± 18 nmol/min/ml). In conclusion, DIO2 Ala92 homozygous variant found to be associated with altered levels of DIO2, Thyroid profile and paraoxonase. Hence, we recommend to do detail study of genetic factors related to thyroid function and prevent additional diabetic complications.     

Altered pattern of lipids in plasma and erythrocyte membranes of rheumatoid arthritis patients

The present study has investigated the levels of lipids, lipoprotein cholesterol (HDL and LDL cholesterol), thiobarbituric acid reactive substances (TBARS) and vitamin E in plasma and erythrocyte membranes of twenty two clinically diagnosed adult rheumatoid arthritis patients and an equal number of age matched healthy subjects. The levels of lipids and lipoprotein cholesterol were markedly reduced in patients with rheumatoid arthritis as compared to healthy subjects. The altered lipid pattern may be related to decreased lipoprotein cholesterol, fatty acids and impairment in antioxidant defence mechanism.     

Lipid profile in middle class Bengali population of Kolkata

Fasting samples of 1396 apparently healthy, middle class Bengali population of Kolkata, West Bengal were tested for total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol and very low density lipoprotein cholesterol, over a period of three years. The values obtained were (in mg/dl) 190±33, 132±42, 53±10, 116±30 and 21±7 respectively. When these subjects were grouped according to the age and sex, no appreciable difference were observed between most of the groups. Triglyceride was found to be low and HDL cholesterol was high in women below 30 years when compared with men of similar age. Beyond 60 years, cholesterol level as well as low density lipoprotein cholesterol was found to be gradually increased in case of women. Besides these changes, other minor differences were not statistically significant. It is suggested that the lipid values of the present study should be taken as a base parameters and the clinical evaluation be made on the basis of these finding.     

Correlation of Cord Blood Lipid Heterogeneity in Neonates with Their Anthropometry at Birth

Objective: Fetus with intrauterine stress may exhibit programmed changes that can alter its metabolism and bear severe risk for diseases in adult life. The current study was designed to assess the correlation between cord blood lipid profile with the anthropometric data in neonates. Materials and methods: 146 newborn babies born at Dr. T M A Pai Hospital, Udupi were screened and their birth weight, length, head circumference and abdominal circumference were noted at birth. Umbilical cord blood samples were analyzed for total cholesterol, triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL). Infants were also grouped further based on gestational age (GA) and sex-adjusted birth weight percentiles into three groups i.e. Small for gestational age (SGA), Appropriate for gestational age (AGA) and Large for gestational age (LGA) for comparison of their lipid profiles. Inclusion criteria were normal fetal heart rate at birth and an APGAR score >7. Statistical significance of relation between lipid profile and anthropometry was done using ANOVA and Pearson correlation coefficient. Results: Triglycerides were significantly higher in babies with higher ponderal index (PI) than those with lower PI (P = 0.011). The TG level of SGA babies were significantly higher as compared to AGA group (P = 0.001). The LDL levels in neonates with higher abdominal circumference were significantly lower than those with lower AC (P = 0.019). Mean HDL levels were higher in neonates with larger AC, but not statistically significant. Maternal BMI had no influence on neonates’ lipid profile. Conclusion: Abnormal intrauterine milieu created by maternal changes during gestation may bear a profound impact on lipid metabolism in neonates, which may account for their differences in lipid profile and anthropometry at birth.     

Evaluation of reference intervals of serum lipid profile from healthy population in Western Maharashtra

Fasting samples of 914 subjects from healthy population were analyzed for total cholesterol, triglyceride and three major fractions of lipoproteins i.e. high-density lipoprotein cholesterol, low lipoprotein cholesterol and very low-density lipoprotein cholesterol. The values obtained were (in mg/dl) 165.7±30.2,88.36±31.2, 44.86±10.68, 101.66±29.8 and 18.11±7.35 respectively. When these subjects were grouped according to the age and sex, no appropriate differences were observed between most of the groups. Triglycerides were found to be low and HDL cholesterol was high in female when compared with male of similar age. Beyond age 40 years cholesterol level and low density lipoprotein cholesterol was found to be gradually increased in case of women. Minor difference was observed with dietary pattern. Present study suggests that clinical evaluation of patient should be made on the basis of these reference values for Western Maharashtra population.     

Does Friedewald Formula Underestimate the Risk of Ischemic Heart Disease?

Traditionally Friedewald formula has been used to calculate low density lipoprotein cholesterol (LDL-C) concentration though now direct homogenous methods for its measurement are also available. Clinical guidelines recommend the use of calculated LDL-C to guide therapy because the evidence base for cholesterol management is derived almost exclusively from trials that use calculated LDL, with direct measurement of LDL-C being reserved for those patients who are non fasting or with significant hypertriglyceridemia. In this study our aim was to compare calculated and direct LDL and their variation at different cholesterol and triglyceride levels. Fasting lipid profile estimation was done on 503 outpatients in a tertiary hospital. Both direct and calculated LDL were then compared. Mean fasting direct LDL was found to be higher than calculated LDL in 87.1 % of subjects by 8.64 ± 8.35 mg/dl. This difference was seen a all levels of cholesterol and triglyceride. Using 130 mg/dl LDL cholesterol as cut off fewer subjects were classified as high risk by calculated LDL than direct LDL. In conclusion, direct LDL is higher than calculated LDL. Compared with direct measurement, the Friedewald calculation underestimates the risk for ischemic heart disease.     

Investigation of ABCA1 C69T polymorphism in patients with type 2 diabetes mellitus

Introduction:

Non insulin dependent diabetes mellitus is the most common type of diabetes. Genetic factors, lipid profiles, hypertension are potential risk factors for diabetes mellitus. Adenosine binding cassette transporter proteins 1 (ABCA1) plays a role in cholesterol metabolism, especially high density lipoprotein (HDL-cholesterol). There are multiple mechanisms by which HDL-cholesterol can be atheroprotective, it is clear that the relative activity of ABCA1 plays a major role. We aimed to investigate association of ABCA1 C69T gene polymorphism with lipid levels in Turkish type 2 diabetic patients.

Materials and methods:

After isolation of DNA by ethanol precipitation we determined ABCA1 gene polymorphism by using polimerase chain reaction - restriction fragment lenght polymorphism (PCR-RFLP) method in 107 type 2 diabetic patients and 50 healthy controls.

Results:

We have observed that the frequency of TT genotype is significantly higher in healthy controls compared to patients (14% vs. 3%; P = 0.008). Also frequency of T allele was higher in controls than in patients (34% vs. 21%; P = 0.020; OR (95% CI) = 0.52 (0.30–0.88)). There was no association of lipid levels and ABCA1 C69T polymorphism subgroups.

Conclusion:

We have found significantly higher frequency of both T allele and genotype in control group when compared to patients that made us think that T allele may be a protective factor against diabetes mellitus. But, we could not find a relationship between genotypes and lipid concentrations in our two groups. Larger studies will help us to understand the relationship between ABCA1 C69T genotype and lipid parameters in diabetes mellitus.     

Serum lipids, lipoproteins and sex-hormone binding globulin in breast cancer

Serum levels of various lipid parameters, i.e., triglycerides, total cholesterol, alpha lipoprotein or high density lipoprotein (HDL)-cholesterol and beta lipoprotein or low density lipoprotein (LDL)-cholesterol were measured in a total of 138 histologically proven cases of breast cancer along with 146 control women. The mean levels of serum triglycerides, total cholesterol and LDL-cholesterol were found to be significantly higher in breast cancer cases as compared to controls. However, lower mean levels of serum HDL-cholesterol and sex-hormone binding glubulin (SHBG) were observed in breast cancer patients than the control subjects. The results indicate a probable relation between serum lipids and the activity of sex-hormones. Moreover, the study reflects an overall disturbance of lipid metabolism in the pathological process of breast cancer.     

Association of Single Nucleotide Polymorphisms of Adiponectin Gene with Type 2 Diabetes Mellitus,and Their Influence on Cardiovascular Risk Markers

Type 2 diabetes mellitus is a genetically heterogeneous condition, characterized by insulin deficiency and/or insulin resistance. The etiology of type 2 diabetes is complex, with involvement of genetic and environmental factors. The adipose tissue protein ‘adiponectin’ is known to increase insulin sensitivity with decreased risk of type 2 diabetes mellitus. The gene for adiponectin is present on chromosome 3q27, the association of number of single nucleotide polymorphisms of adiponectin gene with type 2 diabetes and its complications have been reported. In the present study the two most common SNPs +45T/G & +276G/T, and their association with type 2 diabetes mellitus and cardiovascular markers were studied. The significant difference in genotype frequencies of +45T/G & +276G/T was found in type 2 diabetic patients and controls, with odds ratio of 1.13 & 1.26 respectively. BMI, Fasting blood glucose, fasting insulin, HOMA IR, triglyceride and VLDL cholesterol levels were increased, and HDL cholesterol level was decreased in patients carrier for +45T/G SNP than the wild type. While only decrease in the HDL cholesterol was reported in carriers for SNP +276G/T than the wild type. The logistic regression analysis revealed the positive association of SNP +45T/G with total cholesterol & LDL cholesterol. And negative association of HDL cholesterol was found with SNPs +45T/G and +276G/T. The haplotype analysis shows the alterations in means of biochemical markers in the patients having haplotype (GG) for mutant allele of SNP +45T/G and wild allele for SNP +276G/T.     

Study of lipid peroxide and lipid profile in diabetes mellitus

The study was designed to find out the correlation between lipid peroxidation, lipoprotein levels to severity and complication of diabetes mellitus. Degree of lipid peroxidation was measured in terms of malondialdehyde (MDA) along with lipid profile and blood glucose in diabetes mellitus. It is categorised into insulin dependent diabetes mellitus (IDDM), non insulin dependent diabetes mellitus (NIDDM) and diabetes mellitus(DM) with complication. Total 112 known diabetic patients and 52 non-diabetic controls were studied. These patients were grouped as per the concentration of fasting blood glucose level i.e. controlled, poorly controlled, and uncontrolled group. There are significant increase in the lipid peroxide (MDA) and lipid profile except HDL cholesterol which is decreased, has been found in all groups as compared to controls In NIDDM group lipid peroxidation was markedly increased than IDDM group and it was higher in DM with complications. Other finding observed was that the level of lipid peroxide increased as per the increase in concentration of blood glucose. The increase lipid peroxidation in the hyperglycemic condition may be explained, as the superoxide dismutase enzyme which is antioxidant becomes inactive due the formation of superoxide radical within the cell. Maximum lipid peroxidation leads to the damage of the tissue and organs which results into complication in diabetic patients. High levels of total cholesterol appear due to increased cholesterol synthesis. The triglyceride levels changes according to the glycemic, control. The increase may be due to overproduction of VLDL-TG. It is concluded that good metabolic control of hyperglycemia will prevent in alteration in peroxidation and the lipid metabolism, which may help in good prognosis and preventing manifestation of vascular and secondary complication in diabetes mellitus.     

Serum lipid profile and lipoprotein lipase activity in patients of ischaemic heart disease

Total lipids, cholesterol, phospholipids, free fatty acids, total glycerides and lipoprotein lipase (LPL) activity of 26 patients of Ischaemic Heart Disease (IHD) and similar number of age and sex matched control individuals were studied to find out abnormality in lipid metabolism. Incidence of IHD was more common amongst males as compared to females. Significant low levels of serum LPL activity and higher levels of other parameters was thus evident in patients of IHD and this may explain the altered lipid metabolism and hypertriglyceridemia in patients of IHD.     

Use of glycated hemoglobin (HbA<Subscript>1C</Subscript>) and impaired glucose tolerance in the screening of undiagnosed diabetes in the Malaysian population

Although HbA_1C is widely accepted as a useful index of mean blood glucose in type 2 diabetic patients its usefulness as screening test for diabetes has been controversial. The present study was undertaken to determine whether the level of HbA_1C predicted diabetes in a prediabetic group of subjects. Plasma lipids, oral glucose tolerance, HbA_1C was determined in 90 normal control subjects, 57 offspring of one type 2 diabetes mellitus parent and 11 diagnosed type 2 diabetes mellitus individuals. The mean age of participants was 44.5 yrs (not significantly different amongst the three groups) and the mean body mass index was 26.8 (not significantly different amongst the three groups). Two hours after a 75 g glucose challenge, the offspring had a significantly higher plasma glucose level (mean = 7.1 mmol/L, p value = 0.002) than the normals. Similarly the HbA_1C values were higher in the offspring than in the normals (mean = 5.78%, p value = 0.016). Besides the significantly higher values for oral glucose tolerance test and HbA_1C, the diabetics also were significantly higher for triglycerides (mean = 2.25mmol/L), total cholesterol (mean = 6.24mmol/L) and systolic blood pressure (mean = 138.45mm Hg) than the offspring (P value = 0.031, 0.006, 0.010) and the normals (P value = 0.026, 0.018, 0.002) respectively. The mean values of diastolic blood pressure, LDL cholesterol and HDL cholesterol were not significantly different amongst the three groups.     

Dyslipidemia Associated with Poor Glycemic Control in Type 2 Diabetes Mellitus and the Protective Effect of Metformin Supplementation

The nature of the dyslipidemia associated with diabetes mellitus is complex and is the major risk factor for atherosclerosis and coronary artery disease. Aim of this study was to assess the effect of glycemic control, achieved by metformin, glibenclamide and insulin, on lipid profile in type 2 diabetic patients. One hundred and sixty-five type 2 diabetes mellitus patients were classified into good glycemic control (Group I) and poor glycemic control (Group II) on the basis of their blood HbA1c values. The Group II was characterized with high serum triglyceride (190.46 ± 15.20 mg/dl), total cholesterol (175.3 ± 6.31 mg/dl) as well as high LDL-cholesterol (109.0 ± 5.88 mg/dl). Significant correlations were evident between HbA1c and dyslipidemia, particularly serum TG (r = 0.28, P < 0.05), and between HbA1c and total cholesterol (r = 0.310, P < 0.05). Better glycemic control and improved dyslipidemia were observed in patients on combination therapy of metformin plus glibenclamide.     

Comparison of lipid profile and antioxidant enzymes among south Indian men consuming coconut oil and sunflower oil

In this study, we compared the lipid profile and antioxidant enzymes of normal and diabetic subjects consuming two different types of oil as cooking medium. 70 normal, healthy subjects were taken as controls and 70 subjects with Type 2 diabetes were recruited in patient group. Each group was further subdivided into two subgroups of 35 subjects each, consuming coconut oil and sunflower oil respectively as cooking medium. Samples of blood were collected and analyzed for serum total cholesterol, triacylglycerols, and cholesterol in lipoprotein fractions. Total glutathione and glutathione peroxidase were measured in erythrocytes and superoxide dismutase in serum. Triacylglycerols, LDL and VLDL cholesterol levels were high in the diabetic subjects compared to the controls. Total glutathione and glutathione peroxidase values showed significant decrease in diabetic subjects as compared to the controls, while superoxide dismutase values showed significant difference between coconut oil consuming groups. Though lipid profile parameters and oxidative stress were high in Type 2 diabetic subjects compared to controls, no pronounced changes for these parameters were observed between the subgroups (coconut oil vs. sunflower oil).     

Quantitation of compositional changes in high density lipoprotein fraction in alcoholics and its correlation with liver enzymes

The cholesterol of high density lipoprotein (HDL) and its sub-fractions HDL₂, HDL₃, and apoprotein concentrations were monitored in fifty seven male alcoholic subjects. Thirty five of them had normal liver enzymes and twenty two had abnormal liver enzymes. Subjects with abnormal liver enzymes had elevated cholesterol of high density lipoprotein and its sub-fractions and also Apo AI, AII concentrations in plasma, whereas in the group of patients with normal liver enzymes, the concentrations of lipids and apoproteins did not differ significantly from the control group. The quantitation of HDL cholesterol and its sub-fractions along with Apo AI and AII can be used as indicators to characterise the state of hepatic function.     

Dyslipidaemia Associated with Type 2 Diabetics with Micro and Macrovascular Complications among Ghanaians

In this study, differences in lipid levels amongst diabetics with and without complications were assessed to determine lipid disorders that are associated with diabetic complications other than cardiovascular diseases. A Cross sectional study design was employed. The study included 288 diabetics and 108 non diabetics with different types of complications such as hypertension, nephropathy, neuropathy, and retinopathy. The mean serum total cholesterol was higher in patients with complications compared to those without complications and the non-diabetic controls. The normotensive diabetic patients had the lowest total cholesterol among the diabetic patients’ groups (4.65 ± 0.17 mmol/l) compared to the diabetics with hypertension (6.051 ± 0.20 mmol/l), retinopathy (6.26 ± 0.29 mmol/l), neuropathy (5.80 ± 0.17 mmol/l) and nephropathy patients 5.74 ± 0.26 mmol/l (P < 0.05). The prevalence of dyslipidaemia among diabetic subjects was between 19.2 and 84.0%. The study shows that, in addition to macrovascular complications, dyslipidaemia is common in type 2 diabetes mellitus patients with microvascular complications.     

An Infant with Milky Blood : An Unusual but Treatable Case of Familial Hyperlipidemia

Hyperlipidemia is increasing prevalent risk factor in children, concomitant with worldwide epidemic of obesity. Lipid disorder can occur either as primary event or secondary to an underlying disease. The primary dyslipidemia are associated with overproductions/or impaired removal of lipoprotein. The latter defect can be induced by an abnormality in either the lipoprotein itself or in the lipoprotein receptor. A 2 month old male baby was found to have highly viscous and milky serum. S. Cholesterol was 2,200 mg/dl and triglycerides 13,292 mg%. There was no dysmorphic feature. Child was anemic and had hepatosplenomegaly and xanthomas. There was positive history of hyperlipidemia in first maternal cousin. Parents of index case had normal lipid profile. The child was put on lipid lowering agents, Iron drops, medium chain fatty acid.     

Serum lipids in dilated cardiomyopathy

Serum total cholesterol and triglyceride levels were estimated in 45 dilated cardiomyopathy (DCM) patients and were compared with 31 healthy controls. The total serum cholesterol (215±50 mg/dl) and serum triglyceride (162±76 mg/dl) levels in DCM patients did not show any significant changes as compared to normal controls. The cholesterol and triglyceride and the individual lipoprotein fractions, viz HDL, VLDL, LDL and chylomicrons were analysed in 10 patients. The values did not differ significantly when compared to those of controls. These findings suggest that serum lipids may not play a role in the antietiopathogenesis of DCM.