RESUMEN

AIM: The prevalence of diabetes mellitus among Malaysians aged ≥ 30 years of age has increased by more than twofold over a 20-year period. This study aimed to determine the current status and to evaluate the diagnostic usefulness of the HbA(1c) cut-off point of 48 mmol/mol (6.5%). METHODS: Using a two-stage stratified sampling design, participants aged ≥ 18 years were recruited from five zones selected to represent Malaysia. An oral glucose tolerance test was performed on all those not known to have diabetes. RESULTS: A total of 4341 subjects were recruited. By World Health Organization criteria, the prevalence of diabetes mellitus was 22.9%; of that percentage, 10.8% was known diabetes and 12.1% was newly diagnosed diabetes. Diabetes was most prevalent amongst Indians (37.9%) and Malays (23.8%). Prevalence of new diabetes mellitus was only 5.5% (95% CI 4.9-6.3) when based on the HbA(1c) diagnostic criteria of 48 mmol/mol (6.5%) and, although the cut-off point was highly specific (98.1%), it was less sensitive (36.7%) compared with 45 mmol/mol (6.3%), which showed the optimal sum of sensitivity (42.5%) and specificity (97.4%) in identifying new diabetes mellitus. CONCLUSION: This study recorded an overall diabetes prevalence of 22.6%, almost a twofold increase from 11.6% reported in 2006. This was likely attributable to the higher prevalence of new diabetes (12.1%) diagnosed following an oral glucose tolerance test. An HbA(1c) of 45 mmol/mol (6.3%) was found to be a better predictive cut-off point for detecting new diabetes in our multi-ethnic population.

Asunto(s)

Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Adulto , China/etnología , Etnicidad , Femenino , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada/análisis , Humanos , India/etnología , Malasia/epidemiología , Masculino , Persona de Mediana Edad , Curva ROC , Valores de Referencia , Sensibilidad y Especificidad , Organización Mundial de la Salud

RESUMEN

We evaluated the effects of a standardized Labisia pumila var. alata (LPva) extract on body weight change, hydroxysteroid (11-beta) dehydrogenase 1 (HSD11B1) expressions and corticosterone (CORT) level in ovariectomized (OVX) rats. The decoction of LPva has been used for generations among Malay women in Malaysia to maintain a healthy reproductive system.Thirty-six Sprague-Dawley OVX rats were treated orally with LPva extract (10, 20 or 50 mg/kg/day) or estrogen replacement (ERT) for 30 days. Sham operated rats were used as controls. Compared to untreated OVX rats, LPva-treated rats showed less weight gain and had significantly down-regulated HSD11B1 mRNA in liver tissues. HSD11B1 mRNA in adipose tissues increased by 55% (p < 0.05) in OVX rats but normalized in rats treated with LPva. Similarly, there was significant down-regulation (p < 0.05) of protein levels of HSD11B1 in both liver and adipose tissue of LPva and ERT groups, and CORT levels were significantly reduced in both groups of rats. This is the first study ever conducted to evaluate the beneficial effects of LPva in relation to weight gain caused by estrogen insufficiency. Results implied that the bioactive components in LPva extract affect not only HSD11B1 expressions in both adipose and liver tissues but also decrease circulating CORT. The extract should be explored for its potential use as a natural remedy for weight management.

Asunto(s)

11-beta-Hidroxiesteroide Deshidrogenasa de Tipo 1/metabolismo , Corticosterona/sangre , Extractos Vegetales/farmacología , Primulaceae/química , 11-beta-Hidroxiesteroide Deshidrogenasa de Tipo 1/genética , Animales , Western Blotting , Peso Corporal/efectos de los fármacos , Femenino , Expresión Génica/efectos de los fármacos , Análisis de Secuencia por Matrices de Oligonucleótidos , Ovariectomía , Extractos Vegetales/química , Ratas , Ratas Sprague-Dawley , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: Labisia pumila var. alata (LPva) is a traditional medicinal herb used by Malaysian women to treat many ailments of the genitourinary tract. Its phytoestrogenic properties suggest potential to prevent recurrent urinary tract infection (UTI) in women post menopause. The aim of this study was therefore to investigate the mechanisms of action of LPva in an in vitro model of UTI. MATERIALS AND METHODS: Bladder epithelial cell lines T24 and 5637 and uropathogenic Escherichia coli (UPEC) strain CFT073 were used to model uroepithelial infection. The ability of LPva to induce programmed cell death was tested using the Annexin-V-FLUOS and TUNEL assays. Expression of caveolin-1, ß1 integrin and antimicrobial peptides HBD-2 and LL-37 in response to LPva treatment and/or infection, was assessed using RT real-time PCR. Effects on protein expression were confirmed by Western blot analysis. Sensitivity and yeast agglutination assays were employed to determine if LPva had antimicrobial activities and/or interacted with type 1 fimbriae, respectively. Finally, bacterial adherence and invasion to cells treated with LPva was examined. RESULTS: LPva induced uroepithelial apoptosis which was coupled with upregulated expression of caveolin-1 and downregulation of ß1 integrin. LPva did not exhibit direct antimicrobial properties and did not influence antimicrobial peptide levels in cells. Additionally, LPva did not interact with type 1 fimbriae and did not affect adherence in comparison to non-treated control cells. However, LPva significantly reduced the number of intracellular UPEC in bladder epithelial cells. CONCLUSIONS: Our findings suggest that LPva has beneficial applications against UPEC infection due to its ability to induce programmed cell death and reduce bacterial invasion of the uroepithelium.

Asunto(s)

Apoptosis/efectos de los fármacos , Infecciones por Escherichia coli/tratamiento farmacológico , Fitoterapia , Primulaceae , Vejiga Urinaria/efectos de los fármacos , Infecciones Urinarias/tratamiento farmacológico , Urotelio/efectos de los fármacos , Carga Bacteriana/efectos de los fármacos , Caveolina 1/metabolismo , Línea Celular , Células Epiteliales/efectos de los fármacos , Células Epiteliales/microbiología , Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/metabolismo , Humanos , Integrina beta1/metabolismo , Extractos Vegetales/farmacología , Extractos Vegetales/uso terapéutico , Regulación hacia Arriba , Vejiga Urinaria/microbiología , Infecciones Urinarias/metabolismo , Infecciones Urinarias/microbiología , Urotelio/citología , Urotelio/microbiología

RESUMEN

AIM OF THE STUDY: New options are needed to prevent and treat metabolic disorders associated with polycystic ovary syndrome (PCOS). Labisia pumila var. alata (LPva)-a Malaysian herb thought to have phytoestrogenic effects-has shown promise in reducing body weight gain in ovariectomized rats. In this study, we investigated the effect of LPva on body composition and metabolic features in female rats treated continuously with dihydrotestosterone, starting before puberty, to induce PCOS. MATERIAL AND METHODS: At 9 weeks of age, the PCOS rats were randomly subdivided into two groups; PCOS LPva and PCOS control. PCOS LPva rats received a daily oral dose of LPva (50mg/kg body weight), dissolved in 1 ml of deionised water, for 4-5 weeks. PCOS controls received 1 ml of deionised water on the same schedule. RESULTS: LPva increased uterine weight (27%) and insulin sensitivity (36%) measured by euglycemic hyperinsulinemic clamp. Plasma resistin levels were increased and lipid profile was improved in LPva rats. In adipose tissue, LPva decreased leptin mRNA expression but did not affect expression of resistin and adiponectin. No effects on body composition, adipocyte size, or plasma leptin levels were observed. CONCLUSION: LPva increases uterine weight, indicating estrogenic effects, and improves insulin sensitivity and lipid profile in PCOS rats without affecting body composition.

Asunto(s)

Modelos Animales de Enfermedad , Extractos Vegetales/uso terapéutico , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Síndrome del Ovario Poliquístico/metabolismo , Primulaceae , Tejido Adiposo/efectos de los fármacos , Tejido Adiposo/metabolismo , Animales , Femenino , Malasia , Extractos Vegetales/aislamiento & purificación , Preparaciones de Plantas/aislamiento & purificación , Preparaciones de Plantas/uso terapéutico , Ratas , Ratas Wistar

RESUMEN

The Malaysian National Health Morbidity Survey III (NHMS III), conducted in 2006, was a cross-sectional household survey of the prevalence of chronic diseases, involving 34,539 respondents of age > or =18 years old, in all states of Malaysia. Data collection was by face-to-face interview. Those who self-professed not to be diabetics underwent finger-prick glucose test following at least 8 hours of fasting. The overall prevalence of diabetes mellitus (known and newly diagnosed) was 11.6%. The Indians had the highest prevalence of 19.9% followed by Malays 11.9% and Chinese 11.4%. The prevalence of people with known diabetes and newly diagnosed diabetes was 7.0% and 4.5% respectively. Impaired Fasting Glycaemia was found to be 4.2%. Majority (73.5%) of the patients used government healthcare facilities for their diabetic care. Usage of insulin alone or in combination was low at 7.2% of patients. Only 45.05% of known diabetics have ever had their eye examined. Amputees formed 4.3% of the patients with known diabetes while 3.4% had suffered a stroke event and 1.6% was on some form of renal replacement therapy.

Asunto(s)

Diabetes Mellitus/epidemiología , Encuestas Epidemiológicas , Adolescente , Adulto , Complicaciones de la Diabetes , Diabetes Mellitus/tratamiento farmacológico , Femenino , Humanos , Malasia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven

RESUMEN

BACKGROUND: The role of endothelial injury and circulating adhesion molecule in the development and progression of diabetic peripheral neuropathy in the long-term has been established previously. AIMS: To study the effects of short-term glycemic control using insulin and oral hypoglycemic agent therapy (OHA) on the peroneal nerve function and vascular cell adhesion molecule-1 (VCAM-1) and advanced glycation endproducts (AGE) levels in type 2 diabetic patients. SETTINGS AND DESIGN: A randomized controlled study involving poorly controlled (HbA1c, 7.5%-11%) type 2 diabetic patients attending the endocrinology outpatient center in a tertiary hospital in Kuala Lumpur. MATERIALS AND METHODS: Twenty-nine patients were randomized to receive insulin (n=15) or OHA (n=14) for 8 weeks. The glycemic variables (HbA1c, fasting plasma glucose [FPG], fructosamine), VCAM-1, serum AGE and the peroneal motor conduction velocity (PMCV) were measured at baseline and at 4-week intervals. STATISTICAL ANALYSIS USED: Paired 't' test or Kruskal Wallis test; and the unpaired 't' test or Mann-Whitney U test were used for within-group and between-group analyses, respectively. Correlation was analyzed using Spearman's correlation coefficient. RESULTS: Within-group analysis showed significant progressive improvement in HbA1c at weeks 4 and 8 in the insulin group. The PMCV improved significantly in both groups by week 8, and by week 4 (P = 0.01) in the insulin group. PMCV correlated negatively with VCAM-1 (P = 0.031) and AGE (P = 0.009) at week 8. CONCLUSION: Aggressive glycemic control with insulin improves the peroneal nerve function within 4 weeks. Improvement in the serum VCAM-1 and AGE levels correlated significantly with improvement in peroneal nerve conduction velocity only in the insulin group.

Asunto(s)

Diabetes Mellitus Tipo 2/complicaciones , Neuropatías Diabéticas/tratamiento farmacológico , Neuropatías Diabéticas/etiología , Neuropatías Peroneas/tratamiento farmacológico , Neuropatías Peroneas/etiología , Administración Oral , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Neuropatías Diabéticas/sangre , Femenino , Hemoglobina Glucada/efectos de los fármacos , Productos Finales de Glicación Avanzada/sangre , Humanos , Hipoglucemiantes/administración & dosificación , Inyecciones Subcutáneas , Insulina/administración & dosificación , Malasia , Masculino , Persona de Mediana Edad , Conducción Nerviosa/efectos de los fármacos , Nervio Peroneo/efectos de los fármacos , Nervio Peroneo/fisiopatología , Neuropatías Peroneas/sangre , Factores de Tiempo , Resultado del Tratamiento , Molécula 1 de Adhesión Celular Vascular/sangre , Molécula 1 de Adhesión Celular Vascular/efectos de los fármacos

RESUMEN

OBJECTIVE: We investigated the effects of a standardized water extract of Labisia pumila var. alata (LPva), and compared to estrogen replacement (ERT), on body weight gain, uterus weight, adipose tissue mRNA and protein levels of adipokines in ovariectomized (OVX) rats. METHODS: Eight-week-old OVX Sprague-Dawley rats were administered orally with either 10 mg/kg/day (LPva10), 20 mg/kg/day (LPva20) or 50 mg/kg/day (LPva50) of LPva for 30 days. Sham-operated (Sham) and estrogen-treated OVX rats (ERT, 0.625 mg/kg/day) served as controls. Plasma adipokines were measured, and mRNA expressions of the adipokines were determined in the adipose tissues. RESULTS: ERT- and LPva50-treated OVX rats showed significantly less (p<0.05) weight gain compared to untreated OVX rats. Ovariectomy caused plasma leptin levels to decrease significantly (p<0.05), but when treated with LPva or ERT, plasma leptin increased significantly to levels higher or comparable to that seen in the Sham group. The mRNA expression of leptin was higher in the LPva-treated animals than in all other groups. In contrast, the elevated plasma resistin concentrations in OVX rats were significantly reduced in rats given ERT (p<0.05) and LPva extracts (p<0.05). There was no difference in adiponectin levels in all groups. The uterus to body weight ratio of untreated OVX rats was significantly low compared to Sham (p<0.05), but showed dose-dependent increase upon treatment with LPva. CONCLUSION: The present study provides first evidence that LPva exerts uterotrophic effect and regulates body weight gain by modulating secretion of leptin and resistin, and expression of the adipokines in adipose tissues.

Asunto(s)

Peso Corporal/efectos de los fármacos , Terapia de Reemplazo de Estrógeno , Fitoterapia , Extractos Vegetales/administración & dosificación , Primulaceae , Adipoquinas/sangre , Adipoquinas/metabolismo , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Estrógenos/farmacología , Estrógenos Conjugados (USP)/farmacología , Femenino , Tamaño de los Órganos/efectos de los fármacos , Ovariectomía , Ratas , Útero/efectos de los fármacos

RESUMEN

This is a cross-sectional study conducted from January to September 2004 in a group of school children aged 8 -10 years old. The schools and study subjects were selected using stratified systematic sampling technique. A total of 44 schools and 1100 subjects were selected from schools with iodinator and schools without iodinator. Samples collected were spot urine and drinking water. Dietary and iodised water consumption data were obtained from interviews. A total of 931 subjects (84.6%) responded; 558 (50.7%) from schools with iodinator and 373 (33.9%) from schools without iodinator. Results showed that in more than half (53.8%) of the schools with iodinators, mean water iodine level was below 25 microg/L. The study population in Terengganu was found to be mildly iodine deficient with an overall median urine iodine concentration (uIC) of 74 microg/L. Based on WHO criteria, 4.1% with uIC <20 microg/L (severe), 19.5% with uIC between 20-49 microg/L (moderate), 49.2% with uIC between 50-99 microg/L (mild) and 27.2% was iodine sufficient with uIC >100 microg/L. Majority of the study subjects were found to have high seafood intake (> 90%) and low in goitrogen food intake. This study suggests water iodinator system may not be a suitable method of supplying iodine and an alternative is needed in order to eradicate the iodine deficiency problem seen in some parts of Malaysia.

Asunto(s)

Yodo/administración & dosificación , Yodo/deficiencia , Oligoelementos/administración & dosificación , Oligoelementos/deficiencia , Agua/química , Niño , Estudios Transversales , Ingestión de Líquidos , Humanos , Yodo/química , Malasia , Instituciones Académicas , Oligoelementos/química

RESUMEN

This study determined the effects of palm vitamin E (TRF) diet on the levels of blood glucose, glycated hemoglobin (gHb), serum advanced glycosylation end-products (AGE) and malondialdehyde (MDA) of diabetic Sprague-Dawley rats. The rats received either control (normal rat chow), TRF diet (normal chow fortified with TRF at 1 g/kg) or Vitamin C diet (vitamin E-deficient but contained vitamin C at 45 g/kg). The animals were maintained on the respective diet for 4 weeks, made diabetic with streptozotocin (STZ), then followed-up for a further 8 weeks. At week-4, mean serum AGE levels of rats given TRF diet (0.7 +/- 0.3 units/ml) were significantly lower than those of control or Vitamin C diet rats (p pounds 0.03). The levels increased after STZ and became comparable to the other groups. At week 12, blood glucose (20.9 +/- 6.9 mM) and gHb (10.0 +/- 1.6%) of rats on TRF diet remained significantly low compared to that of control or Vitamin C diet rats (p pounds 0.03). MDA however, was not affected and remained comparable between groups throughout the study. This study showed that TRF may be a useful antioxidant; effectively prevented increase in AGE in normal rats, and caused decrease in blood glucose and gHb in diabetic rats. Further studies are needed to elucidate the mechanisms of action of TRF.

Asunto(s)

Diabetes Mellitus Experimental/dietoterapia , Productos Finales de Glicación Avanzada , Hipoglucemiantes/administración & dosificación , Tocotrienoles/administración & dosificación , Animales , Ácido Ascórbico/administración & dosificación , Glucemia , Diabetes Mellitus Experimental/sangre , Dieta , Hemoglobina Glucada , Productos Finales de Glicación Avanzada/sangre , Hipoglucemia/prevención & control , Masculino , Malondialdehído/sangre , Ratas , Ratas Sprague-Dawley , Estreptozocina

Asunto(s)

Creatina Quinasa/sangre , Hipertiroidismo/enzimología , Tirotoxicosis/diagnóstico , Tirotoxicosis/enzimología , Biomarcadores/sangre , Diagnóstico Diferencial , Síndromes del Eutiroideo Enfermo/diagnóstico , Síndromes del Eutiroideo Enfermo/enzimología , Humanos , Hipertiroidismo/diagnóstico , Hipotiroidismo/diagnóstico , Hipotiroidismo/enzimología

RESUMEN

This study determined the prevalence of glutamic acid decarboxylase antibodies (GAD Ab) in a group of 926 young Malaysian diabetics of three ethnic groups, Malay, Chinese, and Indian. Patients were clinically diagnosed to be Type 1 or Type 2 before the age of 40 years. The overall GAD Ab positivity was 17.4% (161/926), significantly higher in the Type 1 than the Type 2 diabetics (35.5%, 116/329 vs. 7.5%, 45/597, P=0.0001). Compared to GAD Ab negative patients, seropositive diabetics were diagnosed at younger age (21.2+/-0.9 vs. 27.4+/-0.3 y, P=0.0001), had lower fasting (289+/-27.4 vs. 640+/-17.6 pmol/l, P=0.0001) and post-glucagon C-peptide levels (527+/-51.8 vs. 1030+/-28.9 pmol/l, P=0.0001). There were no racial differences in the prevalence of GAD Ab; of the total Type 1, 30.8, 36.4, and 39.4% were Malay, Chinese, and Indian diabetics, respectively and of the total Type 2, 8.8, 8.2, and 4.4% were Malay, Chinese, and Indian diabetics respectively. There was a curvilinear relationship between GAD Ab and the post-glucagon C-peptide levels, suggesting that GAD Ab do play a role in the beta-cells destruction and could be an important immune marker for the LADA group. This study reconfirmed previous reports that the autoimmune mechanisms in the Type 1 Asian diabetics are indeed different from the Caucasians, and further investigations should be carried out to explain the differences.

Asunto(s)

Anticuerpos/análisis , Diabetes Mellitus/inmunología , Glutamato Descarboxilasa/inmunología , Adolescente , Adulto , Edad de Inicio , Anciano , Niño , Preescolar , China/etnología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etnología , Femenino , Humanos , India/etnología , Lactante , Malasia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos

RESUMEN

This cross-sectional study looked at the prevalence of microalbuminuria and retinopathy in a cohort of 926 young, Type 1 and Type 2 diabetes mellitus (DM) patients, and determined the factors which were associated with these microvascular complications. The prevalence of microalbuminuria, defined as the albumin:creatinine ratio > or = 2.5 (for males) or > or = 3.5 mg/mmol (for females), was 13.4% in Type 1 DM, 69.5% in insulin-requiring Type 2 DM and 16% in Type 2 DM treated only with oral hypoglycemic agents. Compared to those with normal renal functions, these patients were older (P < or = 0.01), had significantly elevated blood pressures (P < 0.01 or P = 0.0001), and in the case of Type 1 DM, with a higher body mass index (P = 0.0001) and waist-hip ratio (P < 0.01). The prevalence of diabetic retinopathy in Type 1 DM was found to increase with the duration of diabetes, from 1.4% in the newly-onset (< 5 years), to 9.9% in those with 5-10 years disease, to 35% among patients with more than 10 years of diabetes (P < 0.0001). In this study, it was also observed that 10% of the Type 2 DM patients already had retinopathy within 5 years of diagnosis, and the prevalence increased significantly to 42.9% (P < 0.0001) among patients who had been diabetics for more than 10 years. Stepwise multiple regression analysis showed that besides the disease duration, systolic blood pressure was the most common and significant determinant for both microalbuminuria and retinopathy in both types of DM, thus implying that in order to reduce the risk of microvascular complications in diabetes mellitus, systolic and not just the diastolic blood pressure, should be effectively controlled.

Asunto(s)

Albuminuria/etiología , Complicaciones de la Diabetes , Angiopatías Diabéticas/complicaciones , Retinopatía Diabética/etiología , Hipertensión/complicaciones , Adulto , Estudios Transversales , Diabetes Mellitus/orina , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/orina , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/orina , Humanos , Microcirculación , Persona de Mediana Edad , Sístole , Factores de Tiempo

RESUMEN

Thyroid hormones have been shown to be involved in the regulation of insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) expression. This is a cross-sectional study to look at the effects of thyroid hormone status on the circulating levels of IGF-I and IGFBP-3 in a group of 127 patients, aged 20-80 years, who were hyperthyroid, hypothyroid, rendered euthyroid and clinically euthyroid with normal free thyroxine (fT4), but suppressed thyroid stimulating hormone (TSH) levels. TSH was measured by the IMx (Abbott) ultrasensitive assay, while radioimmunoassays for total T3 and T4 were performed using kits from ICN, USA; fT4 and fT3 using kits from DPC USA; IGF-I and IGFBP-3 using kits from Nichols Institute Diagnostics B.V., Netherlands. Differences in the levels of IGF-I between the 4 groups of patients were significant only in the patients aged 20-40. Mean (+/-SEM) IGF-I levels of hypothyroid patients (169+/-19ng/ml) was significantly lower than hyperthyroid (315+/-26 ng/ml, p=0.003), euthyroid patients (241+/-19 ng/ml, p=0.002) and patients with suppressed TSH (308+/-29 ng/ml, p=0.02). The IGF-I levels of the hyperthyroid and suppressed TSH patients were, however, comparable to age-matched normal subjects (281+/-86 ng/ml). Although there was no difference in mean IGFBP-3 levels between the 4 groups of patients, the levels in the patients aged 20-40 with hyperthyroidism (3.7+/-0.9 microg/ml) and suppressed TSH (3.9+/-1.2 microg/ml) were significantly higher (p=0.02) than age-matched normal subjects (3.1+/-0.8 microg/ml). The IGF-I levels of the thyroid patients aged 20-40 showed significant negative correlation to TSH and positive correlations to the thyroid hormones. Hence, whilst low IGF-I is associated with hypothyroidism, high IGFBP-3 is associated with hyperthyroidism. Our finding that IGFBP-3 remained significantly elevated in patients with suppressed TSH but normalised fT4 and fT3 is important as it suggests a prolonged tissue effect of thyroid hormones on IFGBP-3. As such patients have been shown to have higher risk for atrial fibrillation, the significance and possible role of IGFBP-3 in these conditions should be further elucidated in future studies.

Asunto(s)

Enfermedad de Graves/fisiopatología , Hipertiroidismo/fisiopatología , Hipotiroidismo/fisiopatología , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Tirotropina/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Enfermedad de Graves/sangre , Humanos , Persona de Mediana Edad , Tasa de Secreción/fisiología

RESUMEN

The effect of thyroid hormones on the renin-angiotensin-aldosterone system has not been fully resolved. Highly specific immunoassays for measurement of renin, aldosterone, free T4 (fT4), free T3 (fT3) and ultrasensitive TSH enables a direct and more accurate measurement of these hormones. We investigated the relationship between plasma renin, aldosterone and thyroid hormones in the basal state and after intravenous frusemide. This is a cross-sectional study involving 37 patients with thyrotoxicosis, 42 rendered euthyroid with normal fT4, fT3 and TSH levels, 17 with euthyroid levels of fT4 and fT3 but suppressed TSH, and 11 with hypothyroidism. Basal plasma renin was significantly higher in thyrotoxicosis (63.4 +/- 9.8 microU/ml, mean +/- SEM) compared to euthyroid (32.7 +/- 4.4 microU/ml) and hypothyroid (26.7 +/- 9.8 microU/ml). Basal plasma renin for euthyroid with suppressed TSH (41.0 +/- 7.4 microU/ml) was significantly higher than hypothyroid (p = 0.02). Basal plasma aldosterones were not significantly different except for suppressed TSH (157.7 +/- 13 pg/ml), which was higher than normal (109.9 +/- 10.4 pg/ml; p = 0.04). Following frusemide, plasma renin and aldosterone were significantly increased in all groups. Plasma renin was highly correlated to fT3 (r = 0.405, p < 0.001), total T3 (r = 0.359, p < 0.001), fT4 (r = 0.331, p < 0.001) and TSH (r = 0.300, p < 0.001) in the basal state, but less to total T4 (r = 0.248, p < 0.01). Plasma renin correlated poorly to serum aldosterone (r = 0.212, p < 0.03). This study clearly showed that regulation of renin was mainly influenced by fT3, and that aldosterone response to frusemide was blunted in thyrotoxicosis despite normal electrolytes.

Asunto(s)

Aldosterona/sangre , Renina/sangre , Enfermedades de la Tiroides/sangre , Estudios Transversales , Diuréticos/administración & dosificación , Furosemida/administración & dosificación , Humanos , Hipotiroidismo/sangre , Potasio/sangre , Potasio/orina , Renina/efectos de los fármacos , Sodio/sangre , Sodio/orina , Tirotoxicosis/sangre , Tirotropina/sangre , Tirotropina/efectos de los fármacos , Tiroxina/sangre , Triyodotironina/sangre

RESUMEN

OBJECTIVE: The expression and synthesis of IGF-I and IGFBP-3 have been shown to be regulated by hormones and nutrition. We study the effects of malnutrition and iodine deficiency on these growth factors and the height attainment of a group of children. DESIGN: We measured serum IGF-I and IGFBP-3 levels in a group of Malaysian aborigine children from three jungle settlements; Sinderut and Pos Lanai are known for iodine deficiency and endemic goitre, and Gombak is an iodine replete area with better socioeconomic status. PATIENTS: A total of 246 children were studied, 188 in the age group 4-10 years and 88 in the age group 11-15 years. MEASUREMENTS: All children were assessed anthropometrically and height standard deviation score (SDS) were calculated using the CDC Anthropometric Software package. Malnutrition was confirmed clinically and according to the WHO definition of malnutrition. IGF-I and IGFBP-3 were determined by radioimmunoassay, and T4 and TSH by immunoradiometric assay. RESULTS: Based on the height SDS, Sinderut and Pos Lanai children were significantly more malnourished and stunted than the Gombak children P = 0.0001). T4 levels were significantly lower (P = 0.0001) amongst the 4-10-years old Sinderut (81 +/- 2 nmol/l) than in Pos Lanai (101 +/- 3 nmol/l) or Gombak (123 +/- 3 nmol/l) children. Similar findings were also seen in the older children; mean T4 levels of those from Sinderut and Pos Lanai (83 +/- 3 and 88 +/- 4 nmol/l respectively), were low (P = 0.0001) compared to Gombak (118 +/- 3 nmol/l). Conversely, TSH levels in both age groups of Sinderut children were significantly elevated (P = 0.0001) (3.5 +/- 0.2 and 3.9 +/- 0.3 mU/l respectively) compared to age-matched groups from Pos Lanal (2.1 +/- 0.1 and 2.2 +/- 0.2 mU/l respectively) and Gombak (1.5 +/- 0.1 and 1.5 +/- 0.2 mU/l respectively). IGF-I and IGFBP-3 correlated significantly with the height SDS of the children, In both the 4-10 (r = 0.400, P = 0.0001 and r = 0.365, P = 0.0001 respectively) and 11-15 years age groups (r = 0.324, P = 0.002 and r = 0.533, P = 0.0001 respectively). Correlation between IGFBP-3 and T4 levels was more significant in the younger children (r = 0.412, P = 0.0001). Association between IGF-I and T4 levels was significant only in the 4-10 years age group (r = 0.237, P = 0.001). CONCLUSIONS: Varying duration and degree of exposure to malnutrition and iodine deficiency resulted in different mean levels of T4, TSH, IGF-I and IGFBP-3 in the three areas. The strong positive associations between IGF-I and IGFBP-3 levels and height SDS suggest that these biochemical measurements are indeed useful indicators of growth and nutritional status in children. The significant correlations between T4 and IGFBP-3 and IGF-1 suggests the importance of thyroid hormones in regulating the synthesis of these growth factors. The age-related increase of these growth factors even amongst malnourished, iodine deficient children implies that age-matched reference ranges are essential for proper evaluation of laboratory results.

Asunto(s)

Estatura , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Yodo/deficiencia , Trastornos Nutricionales/sangre , Adolescente , Peso Corporal , Niño , Preescolar , Humanos , Malasia , Nativos de Hawái y Otras Islas del Pacífico , Grupos Raciales , Tiroxina/sangre

RESUMEN

Thyroid function and pubertal development of aborigines (Orang Asli) and Malays at different socioeconomic strata were assessed among 1136 subjects aged 7 years and above. Anthropometric measurements, goitre and pubertal staging were done. Serum thyroxine (T4), triiodothyronine (T3) and growth hormone were measured using radioimmunoassays (RIA) and serum thyroid stimulating hormone (TSH) by immunoradiometric assays (IRMA). It was found that serum T3 in children was significantly higher in Malays from rural areas, girls and children aged less than 13 years. However, in adults, T3 was significantly associated with anthropometric indices. On the contrary, serum T4 levels were higher among children from urban areas. In adults, serum T4 levels were significantly related to nutritional status and they increased according to the levels of social development, being lowest in remote areas and highest in urban areas. However, serum TSH levels were significantly higher in Orang Asli at all ages and among malnourished children. By using multiple regression, apart from age, gender and ethnicity, nutritional status was a significant predictor for T3 levels in children and adults. Presence of goitre was an important factor which determined the T4 levels in children and adults after controlling for other factors. It was also a predictor for TSH levels in children but not in adults. Fasting serum growth hormone (GH) levels were significantly higher among less privileged groups and decreased according to social development. Serum growth hormone was negatively correlated with anthropometric indices and had a significant association with malnutrition.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

Bocio/fisiopatología , Trastornos Nutricionales/fisiopatología , Pubertad/fisiología , Glándula Tiroides/fisiopatología , Hormonas Tiroideas/sangre , Adolescente , Adulto , Pueblo Asiatico , Índice de Masa Corporal , Niño , Femenino , Bocio/etnología , Humanos , Malasia/epidemiología , Masculino , Nativos de Hawái y Otras Islas del Pacífico , Trastornos Nutricionales/etnología , Estado Nutricional , Pubertad/etnología , Grupos Raciales , Análisis de Regresión , Factores de Riesgo

RESUMEN

This is a report of a cross sectional study involving 3 groups of children, moderately malnourished (BMI < 15), mildly malnourished (BMI 15-18) and well nourished (BMI > 18) to determine the differences in hormonal and biochemical parameters between the groups. The children were of age range from 7-17 years old. The children were from the same area with exposure to the same food, drinking water and environment. There were significant differences in the nutritional indices between the three groups. No differences were observed in levels of triiodothyronine (T3), thyroxine (T4) and T3:T4 ratio. Significant difference however was found in the TSH levels using highly sensitive IRMA TSH assays. Moderately malnourished children had higher TSH levels (p < 0.05) compared to mildly malnourished and well-nourished children. No difference was found between the mildly malnourished and well-nourished groups. There were no significant differences in serum cortisols done at similar times, fasting growth hormone and calcium. Serum alanine transminase (ALT) however was higher in moderately malnourished than in well-nourished children. Thus using highly sensitive IRMA TSH assays, we were able to detect differences in TSH levels even though T3, T4 and T3:T4 ratio, cortisol, growth hormone and calcium were normal, implying in moderately malnourished children, a higher TSH drive to maintain euthyroid state.

Asunto(s)

Trastornos Nutricionales/sangre , Tirotropina/sangre , Adolescente , Alanina Transaminasa/sangre , Glucemia/análisis , Índice de Masa Corporal , Calcio/sangre , Niño , Estudios Transversales , Femenino , Hormona del Crecimiento/sangre , Humanos , Hidrocortisona/sangre , Masculino , Evaluación Nutricional , Tiroxina/sangre , Triyodotironina/sangre

RESUMEN

A simple and sensitive double-antibody radioimmunoassay for human growth hormone (HGH) was developed, optimised and validated. The anti-hGH sera raised in 2 rabbits were highly specific with low cross-reactions of 0.19% and 0.3% with human placental lactogen and 0.21% and 0.13% with human prolactin. The mean sensitivity of the assay determined from 28 assays was found to be 0.4 +/- 0.2 mIU/L. Mean recovery of added exogenous hGH was 98.8 +/- 6.8%. Linearity studies of samples diluted at 1:2, 1:4 and 1:8 gave values of 101.3 +/- 5.3%, 109.6 +/- 13.4% and 97.3 +/- 13% respectively of those expected. The reproducibility of the assay was good; within assay coefficient of variation for serum samples with GH concentrations of 2.7, 13.6 and 28.2 mU/l ranged from 5.1 to 8.3% while the inter-assay precision varied from 4.9 to 10.3%. The in-house assay showed good correlation (r = 0.96, p less than 0.001) with a commercial HGH RIA kit (Dainabot, Japan). A reference normal adult fasting GH level of less than 7 mIU/l was established from 95 samples assayed by this method.

Asunto(s)

Hormona del Crecimiento/análisis , Radioinmunoensayo/métodos , Animales , Humanos , Conejos , Juego de Reactivos para Diagnóstico