Lipid abnormalities in chronic renal failure

Lipid abnormalities remain to be a major cause of early mortality in patients with chronic renal failure (CRF). In present study, 114 (one hundred fourteen) CRF patients without any additional cause of dyslipidemia were divided into groups on the basis of etiologies of CRF. Blood samples from each group were analyzed for total cholesterol, triglyceride and HDL cholesterol along with blood urea nitrogen and serum creatinine. 25 healthy individuals without any obvious disease were taken as control. Patients from all the groups showed a marked hypertriglyceridemia of 232 (SD±77) mg/dl (P<0.001) as compared to control. Levels of HDL cholesterol were found to be significantly low 20 (±11) mg/dl (p<0.001) in all the groups. LDL cholesterol showed an increase 104 (±30) mg/dl as compared to control group which is not statistically significant. Present study reveals that, CRF patients show an uniform dyslipidemia irrespective of etiologies leading to CRF. This dyslipidemia is also independent of serum creatinine levels. Although, these lipid abnormalities may not solely cause mortality in CRF patients, they may act as modulators in accelerating atherogenesis which in turn cause early mortality in CRF patients.     

Value of ascitic fluid cholesterol and serum-ascites albumin gradient in differentiating cirrhotic and malignancy related ascites

In a perspective study, the ascitic fluid and serum concentration of total cholesterol, total proteins and albumin in a group of 45 patients was studied. Patients with nonmalignant or cirrhotic ascites were compared with patients having malignancy related ascites and it was proved that the ascitic fluid cholesterol and the serum ascites albumin gradient helped to differentiate cirrhotic from malignant ascites. These two parameters showed a remarkable relationship to the presence/absence of malignancy. Non malignant ascites patients had ascitic fluid cholesterol values of 19.41±8.33 mg/dl, as against the malignancy related ascites patients, who showed levels of 95.87±1.24 mg/dl. Similarly, the serum-ascites albumin gradient levels were 2.89±0.65 in non malignant ascites patients, while the malignancy related ascites cases had 0.86±0.50. The discrimination values for cholesterol were taken as 45 mg/dl while that for serum ascites gradient was taken as 1.1. Levels of serum cholesterol, total protein and albumin were not significantly altered.     

Preliminary studies on serum lipids, apolipoprotein-B and oxidative stress in xanthelasma

Serum lipid profile, apolipoprotein-B (apo-B), malondialdehyde levels(MDA) and superoxide dismutase (SOD) activity were assessed in 12 cases of xanthelasma with and without coronary artery disease (CAD)/hypertension (HTN) and results are compared with healthy controls. Dyslipidemia was found in 65% cases of xanthelasma as compared to 20% healthy controls. Xanthelasma patients had significantly high malondialdehyde (MDA) levels (p<0.01) and significantly decreased (p<0.05) SOD activity as compared to controls. Among xanthelasma patients, xanthelasma with CAD/HTN showed higher total cholesterol (236±32.7 vs 188±24.7 mg/dl), low density lipoprotein cholesterol (157±35.5 vs 113±16 mg/dl) and Apo-B (120.5±9.4 vs 114±19.2 mg/dl) levels as compared to xanthelasma without CAD/HTN. Results of our study indicate that xanthelasma patients with increased apo-B, MDA and decreased SOD need cardiovascular monitoring.     

Blood lipid peroxidation products and antioxidants in senile cataract

Lipid peroxidation products and antioxidants were estimated in either blood, serum or erythrocytes of 25 cases of early and 25 of advanced senile (50–60 years) cataract and 30 persons of age matched healthy controls. Serum lipid peroxidation products (as malondialdehyde) were significantly higher in patients with early senile (0.25±0.05 μm/dl, P<0.05) and advanced senile cataract (0.29±0.05 μm/dl, P<0.001) as compared to healthy controls (0.22±0.07 μm/dl). Erythrocyte superoxide dismutase levels were lower in patients with early senile (730±60.5 units/gm Hb) and significantly lower in advanced senile (712±50.2 units/gm Hb, P<0.05) cataract than those in healthy controls (767±59.5 units/gm Hb). Serum α-tocopherol was significantly lower (P<0.05) in only advanced senile cataract (0.69±0.08 mg/dl) but not in early senile cataract (0.75±0.08 mg/dl) when compared with healthy controls (0.75±0.09 mg/dl). There was no significant difference in the erythrocyte concentration of reduced glutathione and serum levels of total proteins, β-carotene, vitamin A, ascorbic acid, calcium, magnesium and zinc.     

Serum lipoprotein (a) and lipid profile in young South Indian patients with myocardial infarction

Coronary artery disease is now a major health problem in India. In past few decades the battle to reduce the incidence of coronary artery disease has led the researchers to look for various clinical markers, which would help early diagnosis of the diseases. The present study was undertaken to assess the level of lipoprotein (a) [Lp(a)] and few other lipids in selected myocardial infarction (MI) patients below 45 years without having any traditional risk factors but with positive family history. Fasting blood samples were taken from 65 patients and their total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglycerides and serum Lp(a) were determined. The control group consisted of 50 age matched healthy individuals. The mean Lp(a) level was 58.6±3.20 mg/dl in patients and 19.70±0.18 mg/dl in controls. Thus Lp(a) levels were found significantly higher in patients with MI (p<0.05 for patients versus control) as compared to the controls. There was no significant difference in the levels of total cholesterol (TC), LDL, VLDL HDL, TGL as compared to controls but there was an increase in TC/HDL cholesterol ratio. The results of this study suggest that high level of Lp(a) and TC/HDL ratio has a distinctive association with MI, independent of other common coronary risk factors. Hence, Lp(a) level in serum emerges to be a promising marker for diagnosis of coronary artery diseases.     

Blood zinc protoporphyrin, serum total protein, and total cholesterol levels in automobile workshop workers in relation to lead toxicity: Our experience

Blood zinc protoporphyrin (ZPP), serum total protein (TP), and total cholesterol (TC) levels in automobile workshop workers in relation to lead toxicity were analysed. In the present study, automobile workshop workers (healthy male workers at an age between 28 and 35 from four major automobile workshops in Kottayam, Kerala State, India) and the control (male healthy adults at an age between 28 and 35 residing at Aymanam, a distant village at Kottayam District, Kerala having reduced or no chance of lead exposure) displayed significant difference in blood lead (BPb) and blood ZZP (BZPP) level. The mean value of BPb in automobile workshop workers was 15.76±0.33 μg/dl, while in the control it was 8.20±0.15 μg/dl. In automobile workshop workers, the mean value of BZPP was 34.2±0.62 μg/dl. The control group exhibited a mean of 11.5±0.22 μg/dl. Automobile workshop workers exhibited significant increase in BZPP was corresponding to the increase in BPb level. The total protein levels estimated in automobile workshop workers showed significant decrease compared to control individuals, but was within the reference range of healthy individuals. The mean value of TP level in automobile workshop workers and control was 6.9±0.13 g/dl and 7.71±0.18 g/dl, respectively. There was no significant difference in blood haemoglobin (BHb) level among the automobile workshop workers and control. The serum TC level in automobile workshop workers showed significant decrease compared to the control individuals, but was with in the reference range of healthy individuals. The mean level of serum TC in automobile workshop workers was 162.00±3.44 mg/dl and the same in control was 172.86±4.32 mg/dl. The present study affirms occupational lead toxicity in automobile workshop workers and its effect on serum protein and cholesterol levels.     

A rabbit model for studying hypocholesterolemic effect of drugs and hypocholesterolemic effect of extracts of garlic (Allium sativum)

An experimental model of hypercholesterolemic rabbits suitable for studying the hypocholesterolemic effect of compounds was developed. Rabbits were made hypercholesterolemic by oral administration of cholesterol (100mg/kg body weight/day) suspended in groud nut oil by gastric intubation (Ryle's tube). Cholesterol can be given to rabbits from 10 days to 6 months depending on the degree of hypercholesterolemia required and duration of study of hypocholesterolemic effect. In one month cholesterol feeding experiment, the serum cholesterol level in normal controls (not given cholesterol) was 67±11.3 mg/dl and in cholesterol fed animals 191.3±70.6 mg/dl. In 2 months experiment, besides hypercholesterolemia, abnormal serum lipid profile and increase in lipid content in liver, heart and aorta were also seen. To such animals when water and methanol extracts of garlic were given along with cholesterol, there was significant decrease in serum cholesterol level. The advantage of this method over the method in which cholesterol is mixed with diet to induce hypercholesterolemia is that exactly same and calculated amount of cholesterol can be given for each animal. This minimises the variations in serum cholesterol levels in different animals.     

Serum lipids in hypothyroidism: Our experience

In order to determine whether the screening of lipid profile is justified in patients with hypothyroidism we estimated serum lipids in cases having different levels of serum TSH. 60 patients of hypothyroidism in the age group of 20 to 60 yrs were studied for thyroid profile over a period of one year. On the basis of serum TSH level the cases were divided into three groups: In the first group TSH concentration was 8.8±2.99 μlU/ml, 95% confidence interval (Cl) 8.8±1.07, whereas serum total cholesterol and LDL-chol levels were 196±37.22 and 126±29.17 mg/dl respectively. The statistical analysis of these two groups showed a significant correlation between raised TSH levels and serum total cholesterol and LDL-chol (P<0.05 & P<0.01) respectively. We conclude that hypothyrodism is associated with changes in lipid profile.     

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.     

Study of Common Genetic Variant S447X in Lipoprotein Lipase and Its Association with Lipids and Lipoproteins in Type 2 Diabetic Patients

Elevated plasma triglyceride and non-esterified fatty acid concentrations may cause insulin resistance and type 2 diabetes mellitus. Lipoprotein lipase (LPL) is a rate-determining enzyme in lipid metabolism. A variant in the LPL gene has been identified which alters the penultimate amino acid Serine at 447 to a stop codon (S447X), and results in a truncated LPL molecule lacking the C-terminal dipeptide Ser–Gly. The present study was designed to evaluate the frequency of S447X variant in the LPL gene and its effect on the lipid and lipoprotein levels in type 2 diabetic subjects. The genotype frequency distributions of type 2 diabetes patients and controls were in Hardy–Weinberg equilibrium. Comparison of the genotype and allelic frequencies of S447X in subjects with type 2 diabetics compared to controls demonstrated no significant difference. In subjects with type 2 diabetics having hypertriglyceridemia (TG ≥ 150 mg/dl) compared to diabetics with TG level <150 mg/dl, significant difference in genotype frequency was found among these groups, while allelic frequency of X was significantly differed. Logistic regression analysis showed the negative association of LPL S447X variant with TG and VLDL cholesterol, while no association with total cholesterol, HDL cholesterol and LDL cholesterol was found. The lipid levels except for HDL cholesterol were found to be significantly lower in carriers for S447X than wild type in diabetes group. The decreased level of TG and TG rich lipoprotein in subjects with SNP S447X in LPL, predicts anti-atherogenic activity of carriers for S447X variant in general population as well as type 2 diabetic patients.     

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.     

LP(a) phenotypes and levels in angiographically proven coronary heart disease patients and controls

Lipoprotein Lp(a) excess has been identified as a powerful predictor of premature atherosclerotic vascular diseases. To evaluate this in a North-Indian population, 130 CAD patients and 130 controls were analyzed. The size of the apo(a) phenotypic isoforms was inversely proportional to Lp(a) concentrations. The mean concentration of Lp(a) in the CAD patients was 42±34 mg/dl whereas in the normal subjects it was much lower, 27±27 mg/dl. 157 subjects out of the total 260 subjects showed plasma levels of >20mg/dl. The frequency of high Lp(a) levels was much higher in patients(73%) than controls (43%). These data suggest (1) that there is heterogeneity of the Lp(a) polymorphism, (2) Higher Lp(a) levels were found in patients than in the controls, (3) Patients showed 1.5 fold increase in Lp(a) levels as compared to the controls. We conclude that low molecular weight apo(a) isoforms are significantly associated with increased risk of CAD in the North-Indian population.     

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.     

Interference in autoanalyzer analysis

This paper presents certain simple procedures for assessing the most common types of interference, due to haemolysis, icterus or lipaemic serum in 19 routine Clinical Chemistry tests and suggests steps to overcome the problem in some tests. A change in the measured concentration, to be analytically significant, had to exceed 2.8 X % coefficient of variation (cv) of the intra-assay analytical variation of each assay. Haemolysis caused interference in 10 of the 19 assays investigated. A haemolysate haemoglobin concentration of 0.29 g/dl, visible to the eye, caused an analytically significant increase in creatinine kinase MB subunit (CKMB), lactate dehydrogenase (LDH), total protein, triglyceride, uric acid and urea, and a significant decrease in alkaline phosphatase (ALP), and total bilirubin. A higher concentration of haemoglobin (0.68 g/ dl) caused an additional significant increase in CK, and a decrease in direct bilirubin. Addition of bilirubin caused interference in all the peroxidase linked reactions as well as in the creatinine assay. At a serum concentration of 5.2 mg/dl it caused a decrease in creatinine, glucose, triglyceride and uric acid. At a higher concentration (15.9 mg/dl) it also decreased cholesterol. Lipaemia interference affected the least number of assays. An added triglyceride of 537–561 mg/dl caused an increase in glucose, uric acid, and amylase. At a level of 1122 mg/dl it also increased CKMB, and at a value of 2244 mg/dl it increased total and direct bilirubin. At the highest levels of haemolysis and lipaemia, the serum glutamate oxaloacetate transaminase (GOT) and giutamate pyruvate transaminase (GPT) gave erratic results. Overall uric acid and CKMB were the analytes most susceptible to interference, while serum caicium and phosphate did not suffer from any. The interference depends on the exact assay conditions used and the susceptibility of each individual laboratory's tests should be determined by them. The reasons for the interferences described are discussed.     

Comparative account of serum lipids,lipoproteins and apolipoprotein-B in patients of coronary artery disease

Serum total lipids (cholesterol and triglyceride), lipoproteins (VLDL, LDL and HDL) and Apolipoprotein-B levels of normal healthy individuals (n=25) and coronary artery disease patients (n=25) were estimated. The objective of the present study was to ascertain the role of apo-B in causation and inheritance of coronary artery disease. It was observed that on an average serum total cholesterol and triglyceride more than 200 mg/dl bring the individuals to a risk of coronary artery disease (CAD) irrespective of the age. CAD patients achieved this value at an early age (35–45 years). Similarly VLDL and LDL levels were found to be significantly raised in CAD patients when compared to that of age matched normal individuals, with patients achieving risk values at an early age. HDL levels were found to be significantly lower in CAD patients as compared to normal individuals. Serum apo-B levels were significantly raised in CAD patients as compared to age matched normal individuals. Patients with positive family history of CAD had raised serum apo-B levels than those having negative family history. A positive coefficient of correlation was observed between serum apo-B and LDL levels suggesting that more the number of Apo-B particles, more will be the synthesis of atherogenic particle (LDL). Patients with negative family history had serum apo-B levels closer to those of normal individuals and in these individuals HDL levels were found to be significantly lowered, suggesting that loss of scavenger role of HDL could be the risk factor responsible for the causation of CAD in these patients, with negative family history of coronary artery disease.     

Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke

Stroke is the third leading cause of death and foremost cause of disability. Based on studies in CAD patients, a focus has been shifted on genetic and inflammatory markers as risk factors for stroke besides deranged lipid profile. The present study was aimed to ascertain the role of Lipoprotein (a), C-Reactive protein (CRP) levels and lipids in patients of ischemic stroke. The study was done in 82 subjects including 40 Computerized Tomography (CT) proven patients of ischemic stroke and 42 age and sex matched controls. Complete biochemical parameters including lipid profile were carried out on autoanalyzer using standard kits and reagents. Lipoprotein (a) [Lp(a)] was determined by immunoturbidimetric assay. Atherogenic indices (Total cholesterol/ HDL, LDL/HDL and Lipid Tetrad Index) were calculated using these lipid parameters. The CRP levels were measured semi-quantitatively by latex agglutination test method. Out of 40 stroke patients, 38 had abnormalities in lipid profile (As per ATP III guidelines). A significant difference was seen in serum cholesterol, LDL cholesterol and atherogenic indices between the patients and controls. The difference in CRP levels in cases and control subjects was highly significant (4.78±0.72 mg/dl vs 0.76 ±0.70, p<0.001). 96.5% of patients with raised CRP had abnormal lipid levels also. CRP levels in stroke patients showed significant correlation with total cholesterol and LDL (p<0.001), Lp (a) (p=0.002) and atherogenic indices (p<0.05). Raised CRP levels in stroke patients were significantly associated with large territory infarcts, severe disability and poor functional outcome (p<0.05).Genetic [Lp(a)], metabolic (deranged Lipid profile) and inflammatory factors (CRP) together are instrumental in causing cerebrovascular arteriosclerosis leading to ischaemic stroke and can be used as important markers to identify patients at risk of severe stroke and to institute aggressive preventive strategies.     

Metabolic alterations during Ramadan fast

Some biochemical parameters in 12 young Muslim students who underwent fasting during the entire one month period of Ramadan were investigated. There was a significant reduction in their body weight (72.5±4.0 to 69.4±3.0 kg) and blood glucose levels (99.6±3.5 to 82.9±7.3 mg/dl). Though the morning plasma cortisol fell (215.2±22.1 to 105±11.2 μg/l) and the evening plasma cortisol rose (58.4±5.1 to 64.4±4.8 μg/l) significantly there was no reversal of the circadian rhythm of cortisol secretion. A decline in the diastolic blood pressure (80 to 75±6 of Hg) of these individuals though not significant was also noted. However, cholesterol (160.9±12.8 to 178.2±40.6 mg/dl) and HDL-Cholesterol (42.6±2.2 to 48.1±2.4 mg/dl) showed a tendency for increase. All the changed values were within the normal range.     

Serum Level of Some Minerals during Three Trimesters of Pregnancy in Iranian Women and Their Newborns: A Longitudinal Study

Concentrations of various trace elements are altered during pregnancy with changes in the mother’s physiology and the requirements of growing fetus. The aim of the present longitudinal study was to learn the changes of micronutrients Iron (Fe), Calcium (Ca), zinc (Zn) Magnesium (Mg) and copper (Cu) of pregnant woman and their relations with newborns levels. Serum levels of iron, calcium, zinc, magnesium and copper of 162 pregnant women and their newborns were determined by an inductively couple plasma mass spectrometer (ICP/MS). The results showed that majority (41 %) of pregnant women were in age group 26–36 years 55 % had high school and diploma levels of education and the total income ranged between 3 and 5 Rials million per month There was significant difference in iron levels during first, second and third trimesters, 76.0 ± 17.8, 63.5 ± 15.2 and 70.1 ± 14.4 μg/dl respectively. Significant difference was shown in zinc levels 79.5 ± 15, 74.5 ± 16.1, and 65.3 ± 14.9 μg/dl during three trimesters. Copper levels during pregnancy were significantly different (130.9 ± 43.5, 172.0 ± 38.94, 193.2 ± 28.5 μg/dl. The serum levels of calcium and magnesium during pregnancy were constant (Ca: 8.96 ± 0.48, 8.86 ± 0.47, 8.91 ± 0.42 mg/dl and Mg: 2.10 ± 0.21, 2.08 ± 0.28, 2.09 ± 0.29 mg/dl). Results showed that 13 % of pregnant women had hypocalcaemia and hypomagnesaemia. Thirty eight percent and 42 % of pregnant women had iron and zinc deficiency respectively. In this study, unlike zinc, no pregnant women were found deficient in serum copper levels. Calcium, iron, zinc, copper and magnesium levels in the newborn’s cord blood were 8.93 ± 0.43, 106.0 ± 26.1, 85.35 ± 16.6, 57.04 ± 13.8 and 1.99 ± 0.27 mg/dl respectively. In the present study the levels of iron and zinc in cord blood were higher than the levels of iron and zinc in maternal serum. The mean level of copper in cord blood serum in the current study was lower than maternal values. The mean serum calcium and magnesium in the serum cord blood and in the serum of the pregnant women were similar.     

Plasma proteins and proteinuria in gestational malaria

The plasma concentrations of total protein, albumin, immunoglobulins IgG, IgA and IgM and urinary protein were assayed in 250 pregnant Nigerian women with malaria and compared with 250 healthy pregnant women which served as controls. The mean values of plasma total proteins, albumin, IgG and IgA were significantly lowered (P<0.05) while a slight increase in IgM was observed in the malaria patients. Urinary proteins value of 23.10±0.50 mg/dl was obtained for the pregnant women with malaria, this was significantly higher (P<0.05) than that of the controls with the corresponding value of 15.32±0.09 mg/dl. This study has therefore demonstrated elevations of the urinary and decrease in plasma proteins in gestational malaria. These findings suggest that the protein profile should be considered in the diagnosis and treatment of malaria.     

Assessment of Insulin Resistance and Metabolic Syndrome in Drug Naive Patients of Bipolar Disorder

The levels of fasting glucose, fasting insulin, insulin resistance (IR) and the prevalence of metabolic syndrome (MS) in a sample population of bipolar disorder (BPD) patients who were newly diagnosed and psychotropically naïve were assessed and compared with an age, sex and racially matched control population. 55 BPD-I patients (15–65 years) who were non-diabetic, nonpregnant, and drug naïve for a period of at least 6 months were included in the study. Diagnosis was made using the structured clinical interview for DSM-IV axis I disorders (SCID IV). IR was assessed using homeostasis model of insulin resistance (HOMA-IR); MS was defined according to National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Data were compared with 25 healthy controls. BPD patients had significantly higher mean levels of fasting plasma insulin (13.2 ± 9.2 vs. 4.68 ± 3.1 μIU/ml, p < 0.05), postprandial plasma insulin (27.2 ± 14.5 vs. 18.1 ± 9.3 μIU/ml, p < 0.05) and a higher value of HOMA-IR (3.16 ± 2.2 vs. 1.19 ± 0.8, p < 0.05) when compared to the controls. A significantly higher proportion of patients of BPD compared to controls were manifesting levels of fasting plasma glucose, serum triglyceride and blood pressure higher than the cut off while waist circumference and serum HDL cholesterol failed to show any significant difference in the proportion. There was a significantly higher proportion of prevalence of IR between BPD cases and controls (26/55 vs. 2/25, z value 9.97, p < 0.05) while there was no significant difference in proportion of prevalence of MS between these two groups. Within BPD patients, logistic regression analysis showed that age, sex or current mood status (depressed/manic) were not significantly predictive of presence or absence of MS or increased IR.