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Open access

Anca Hâncu and Gabriela Radulian

Abstract

Background and Aims: The aim of the present study was to investigate the relationship between visceral fat area (VFA), estimated by bioimpedance, and cardiovascular risk factors independent of BMI and waist circumference in a cohort of Romanian patients. Material and Methods: This was a cross-sectional study, in which were collected data from 751 patients ≥18 years of age from Cluj-Napoca. Anthropometric, biochemistry, body composition and medical history parameters were recorded from patients’ files. Results: Compared with the participants with VFA <100 cm2, those with VFA ≥100 cm2 had significantly worse levels of the laboratory parameters describing the glycemic metabolism, lipid metabolism and liver functions (p <0.05 for all). A higher percentage of participants with VFA ≥100 cm2 had diabetes, obesity, hypertension, hypertriglyceridemia and hypo-HDL cholesterolemia (p <0.05 for all). VFA was correlated with systolic and diastolic blood pressure, total and LDL-cholesterol levels, triglycerides, ALT, previous diagnosis of diabetes, hypertriglyceridemia and hypo-HDL cholesterolemia independent of BMI and waist circumference. Conclusions: Among this cohort of Romanian adults, an increasing level of visceral adiposity was correlated with worse lipid and glucose metabolism parameters as well as with increased levels of ALT, which probably reflects liver fat deposition.

Open access

Marilena Stoian, Victor Stoica and Gabriela Radulian

Abstract

Background and Aims: Metabolic syndrome represents a cluster of cardiovascular risk factors and reached epidemic proportions. It was hypothesized that disturbances in phosphate metabolism may represent a feature of the metabolic syndrome. The aim of the study was to investigate the relationship between phosphate levels and the presence of metabolic syndrome components, as well as the putative mechanism for reduced phosphate level in metabolic syndrome. Materials and Methods: We enrolled 155 subjects: 64 with metabolic syndrome and 91 controls. Biochemical parameters of the metabolic syndrome study population were compared with the healthy population. Results: Patients with metabolic syndrome showed significantly lower phosphate (46%) and magnesium levels compared with controls (22.7%) (p<0.001). Women showed significantly greater serum phosphate levels than men (3.32 mg/dl versus 3.18 mg/dl) (p<0.03). Serum magnesium levels did no differ significantly between men and women. Fractional phosphate excretion rates in patients with metabolic syndrome were similar with controls (10.1±10.2% vs 13.1±9.9%), as well as fractional magnesium excretion (3.1±1.6% vs 2.8±1.3%). Conclusions: Patients with metabolic syndrome show significantly lower phosphate and magnesium concentrations compared to controls. This reduction is likely to be attributed to internal redistribution of phosphate and is more pronounced as the number of components of metabolic syndrome increases

Open access

Mihaela Posea, Andreea Dragomir and Gabriela Radulian

Abstract

Background and Aims: The aim of this study was to document the eating habits of normal weight and obese patients in order to implement a new and healthier lifestyle. Material and Methods: We evaluated the intake of energy and that of vitamins and minerals in a sample of 199 normal weight and obese subjects. We also performed anthropometric's measurements, paraclinic’s and laboratory’s tests. Results: The mean intake of vitamins and minerals is significantly different for B1 and B3 vitamins and for iron, phosphorus, copper and selenium. Vitamins like B1, B2, B3, B6, B12, C and A vitamin and minerals like, zinc, manganese, phosphorus and selenium are over consumed in both groups. Regarding the sodium’s intake, only 37.04% of normal weight patients fulfill the recommendations of less than 2 g/day. The prevalence of a high fat diet is about 59.29% in normal weight people and 60.69% among obese ones. Only 25% of normal weight patients had normal abdominal circumference and 58.47% of obese subjects had normal HDL-cholesterol levels. Conclusions: Regardless the body mass index (BMI) status, neither normal weight subjects nor the obese ones' had an adequate micronutrient intake. Also, there is a high prevalence of high sodium’s intake and a high fat diet among the normal weight patients.

Open access

Ileana Teodoru, Iulian Mincu and Gabriela Radulian

Abstract

Since the Brenner`s theory of the „workload” in the remnant nephrons, due to the largely available access to the dialysis facilities, many patients with advanced chronic kidney disease (CKD) were given low-protein diets (LPDs) apparently with great success. Four main diets are today accepted for achieving a balanced intake of 0.6 g protein/kg/day diet and together with a very low-protein diet of 0.3 g protein/kg/day with keto-analogues and amino-acids supplementation, known as keto-diet, are recommended in specific situations. Still, some questions have debatable answers and are waiting for more conclusive studies: are low and very low-protein diets (VLPDs) really effective in diabetic CKD?; which LPD should be given? and what strategy should be used in order to get maximum compliance and best outcomes?

Open access

Anca Hâncu, Florin Mihălţan and Gabriela Radulian

Abstract

High prevalence of noncommunicable diseases with their associated costs are related more and more to unhealthy behaviours such as unappropriated diets, lack of physical activity and smoking. Lifestyle medicine is now more and more scientific and with evidence-based fundament. The key in lifestyle change is negotiation and cooperation. Physicians should do more than education, should empower and motivate the patient in planning a healthy lifestyle leading to sustained change.

Open access

Irina Duţă, Emilia Rusu, Adrian Costache, Gabriela Radulian and Daniela Adriana Ion

Abstract

Background and Aims. Insulin resistance is documented in type 1 diabetes and it has been associated with chronic complications. Diabetic nephropathy is a major cause of morbidity and mortality. The purpose of this article is to quantify insulin resistance in type 1 diabetes subjects according to the presence or absence of advanced renal disease. A secondary objective was to study the possible association between insulin resistance and advanced renal disease.

Material and Methods. This was a cross-sectional study that included 167 type 1 diabetes patients. Insulin resistance was determined using the eGDR (estimated glucose disposal rate) formula. The association between eGDR and diabetic nephropathy was assessed in uni and multivariate models using stepwise logistic regression analysis of variables. The contribution of individual predictors in the final regression model was examined using Wald statistic.

Results. Significantly lower eGDR’s values were observed in patients with nephropathy: 5 vs. 7.3 (p<0.001). In univariate analysis eGDR was significantly associated with diabetic nephropathy (p<0.001). eGDR variable was retained in the final model of stepwise logistic regression (p<0.001) and showed the strongest association with diabetic nephropathy (Wald = 30.4).

Conclusions. In type 1 diabetes patients insulin resistance was the most important independent risk factor associated with advanced renal disease.

Open access

Andreea Dragomir, Emila Rusu, Mihaela Posea and Gabriela Radulian

Abstract

Background and Aims: To assess the impact of 1 year administration of omega-3 fatty acids supplements on oxidative stress parameters and atherosclerosis progression. Material and Methods: A total of 284 patients with metabolic syndrome, aged 61±6.7 years, without clinical evidence of atherosclerosis were allocated to 2 groups, matched by sex and age: group A (140 patients) - diet according to ESC/EASD recommendations; group B (144 patients) - the same diet + capsules of fish oil (1g eicosapentanoic acid, 1g docosahexanoic acid, 0,1g a-tocopherol acetate). Body fat (BF) was measured by bioimpedance analysis. For oxidative stress evaluation we used the FormOx systems monitor on a blood drop and for progression of atherosclerosis the intima-media thickness (IMT) at common carotid artery. Patients were evaluated at baseline, after 6 months and 1 year. Results: IMT significantly decreased in group B vs group A at 1 year (p<0.0001) and was correlated with %BF (p<0.001), waist-to-hip ratio (WHR) (p=0.002), leptin (p< 0.001), adiponectin (p<0.05), leptin/adiponectin ratio (p< 0.001) and oxidative stress (p<0.001). Conclusions: One year administrations of omega-3 PUFA enriched diet reduces cardiovascular risk of metabolic syndrome patients, resulting in a significant decrease of oxidative stress and atherosclerosis progression.

Open access

Ramona Maria Draguţ, Emilia Rusu, Georgiana Enache, Horaţiu Popescu, Raluca Nan and Gabriela Radulian

Abstract

Chronic liver diseases and metabolic disorders represent two real public health problems that cause increased morbidity and mortality in a significant number of people worldwide. The most common cause of chronic liver disease is represented by non-alcoholic fatty liver disease (NAFLD). Hepatic inflammation is a critical event in the progression of NAFLD and excess adiposity, through the hormones and cytokines secreted by the adipose tissue, plays an important role. There is ample evidence supporting a significant association between chronic hepatitis C (CHC) and metabolic disorders. CHC may be considered not just a viral disease, but also a metabolic type condition. Multiple pathogenic mechanisms have been proposed to explain the interaction between hepatitis C virus and impairment of glucose and lipid metabolism and diabetes. The relationship between hepatitis B infection (HBV) and metabolic diseases remains uncertain.

Open access

Ioan Marin, Roxana Zaharia, Leonard Lupu, Emilia Rusu and Gabriela Radulian

Abstract

Background and aims: The treatment of diabetic foot complications is combined, surgical and medical. The aim of our study was to assess the results of antimicrobial therapy in diabetic foot infections. Material and methods: 100 patients with diabetic foot infections admitted in the Surgery Clinic “I. Juvara” between December 2010 and February 2011 were analyzed. Results: Mean age at presentation was 58.4±9.74 years for women and 63.2±10.53 years for men. Mean diabetes duration was 12.3 years in men and 15.7 years in women. Patients with peripheral arterial disease represented 45% of cases, patients with neuropathy represented 16% of cases and patients with both conditions 39% of the cases. 41 patients suffered minor surgical interventions, 36 patients experienced minor amputations and 23 major amputations (below or above the knee). Antibiotic treatment included cephalosporins, fluoroquinolones and combinations with Metronidazole. After treatment, 74% of patients had a good postoperative evolution. For 26 patients a change of the antibiotic was necessary but only in 10 cases this was made according to antibiogram. Conclusions: Surgical debridement and wound management, carefully chosen antimicrobial therapy and treatment of comorbidities are very important for a successful outcome. Initial empirical antibiotic selection should be followed by culture-guided definitive therapy.

Open access

Georgiana Enache, Emilia Rusu, Alexandra Ilinca, Florin Rusu, Adrian Costache and Gabriela Radulian

Abstract

Background and Aims: This study’s aim was to evaluate the prevalence of obesity and new cases of diabetes in Roma population compared to ethnic Romanian Caucasians from Călăraşi County in the south part of Romania.

Material and Methods: The population included in this study is part of a larger project that aims to evaluate the prevalence of obesity, prediabetes and diabetes in the Roma population from Călăraşi County. So far we have included 344 people: 180 Roma (119 female/61 male), and 164 non-Roma (108 female/56 male) aged between 18 and 85.

Results: In Roma population, the prevalence of underweight, normal weight, overweight and obesity was 4.4% (n=8), 37.2% (n=67), 26.7% (n=48) and 31.7% (n=57) respectively. In Romanian Caucasians, the prevalence of overweight and obesity was 37.2% (n=61) and 32.3% (n=53) respectively. Diabetes was diagnosed in 14.6% (n=24) of Romanian Caucasians and in 11.7% (n=21) of Roma population. Risk factors for obesity in Roma population were: lower socio-educational level, smoking, physical inactivity (active less than 30 min/day).

Conclusions: High prevalence of overweight (26.7%), obesity (31.7%) and new cases of diabetes (11.7%) among the Roma population in the south part of Romania, Calarasi County was an important finding of our study. We observed a negative effect of lifestyle behaviours on health-related outcomes: smoking, sedentariness, lower socio-educational level.