Aleksandra Klisic, Nebojsa Kavaric, Ivan Soldatovic, Bojko Bjelakovic and Jelena Kotur-Stevuljevic
Background: Since the cardiovascular (CV) risk score in the young population, children and adolescents, is underestimated, especially in developing countries such as Montenegro, where a strong interaction exists between the genetically conditioned CV risk and environmental factors, the purpose of this study was to estimate CV risk in apparently healthy adolescent girls. Moreover, we aimed to test some new, emerging CV risk factors and their interaction with the traditional ones, such as obesity. Precisely, we aimed to assess the impact of low bilirubin levels, as a routine biochemical parameter, as an additional risk factor for atherosclerotic disease in the adult phase.
Methods: Forty-five obese adolescent girls (mean age 17.8±1.22 years) and forty-five age-and sex-matched normal weight controls, all nonsmokers, were included. Anthropometric and biochemical parameters were measured. Cardiovascular Risk Score (CVRS) was calculated by adding the points for each risk factor (e.g. sex, HDL-c, non-HDLc, blood pressure and fasting glycemia).
Results: A significant positive relationship between CVRS and ALT, hsCRP and TG/HDL-c, but an opposite relationship between CVRS and total bilirubin were found (P<0.001). Multiple linear regression analysis showed that higher waist circumference (WC) and LDL-c, but lower HDL-c were independent predictors of lower bilirubin values (adjusted R2=0.603, P<0.001).
Conclusions: Obese adolescent girls are at an increased risk of cardiovascular disease late in life. In addition to the traditional risk factors, total bilirubin may have the potential to discriminate between low and higher risk for cardiovascular disturbances in healthy adolescent girls.
Andrijana Milošević Georgiev, Jelena Kotur-Stevuljević and Dušanka Krajnović
Smoking rates in Serbian adults are among the highest in Europe. The objective of this study is to assess the prevalence of smoking and smoking-related behaviours of Belgrade University students depending on their sociodemographic characteristics and faculty group.
A cross-sectional study was carried out among 2,608 Belgrade University students (59.6% female) in 2015. A self-administered questionnaire was applied to the opportunity sample to collect the data describing students’ smoking habits and attitudes across all 30 faculties of the university.
30.5% of students reported smoking: 26.4% of medical, and 31.1% of non-medical ones. Smoking rate among female students was 31.2% vs. 29.5% among males. Age (p=0.001), relationship (<0.001) and employment status (p=0.002) had statistically significant influence on smoking status, while the differences in smoking status between genders (p=0.141) and medical and non-medical group of students (p=0.066) were not statistically significant. The highest percentage of students started smoking during high school (66.2%). As the most common reason to start smoking, respondents cited peer influence (36.5%). 44.3% of students who smoked unsuccessfully tried to quit smoking.
To combat high smoking prevalence among a younger population, the formal education of students about the adverse impacts of smoking should be integrated in all active anti-smoking programs. Medical students, as future healthcare professionals, can play an important role in smoking rates reduction among both younger and general populations, if properly trained and educated about smoking prevention and cessation techniques.
Andrijana Milošević Georgiev, Dušanka Krajnović, Jelena Kotur-Stevuljević, Svetlana Ignjatović and Valentina Marinković
A number of risk behaviours, such as smoking, overweight, excessive alcohol intake, insufficient physical activity, excessive and frequent intake of salt, reduced fruit and vegetable intake, increased fat intake, which constitute living habits of an individual can influence the occurrence of hypertension and hyperglycaemia. The changing of these lifestyles can reduce the risk of developing prehypertension and prediabetes. The survey was conducted at student’s campuses. The respondents were subjected to the height, weight, blood glucose and blood pressure. Respondents filled in previously created questionnaire that was approved by the Ethics Committee for Biomedical Research Faculty of Pharmacy, University of Belgrade. The percentage of respondents with a glucose value above the reference value was 14.6% (n=19), 2.4% (n=3) had values greater than 7 mmol/L without being diagnosed with diabetes, and accordingly, 2.4% (n=3) had elevated HbA1c values (above 42 mmol/mol or 6.0%). The percentage of respondents with elevated systolic and diastolic blood pressure was 14.9% and 7.4% respectively. Regarding calculated risk scores, they showed parallel increase with increas-ing of BMI (HPS), systolic and diastolic pressure (OHS), and glucose concentration (OPS). When analysing all the factors that could cause the later development of diabetes, which is associated with hypertension as well, it is observed that the student population is very much exposed to those factors. The results of this study cannot be representative for the general population of students, but they can provide recommendations for further research.
Ivana Đuričić, Jelena Kotur-Stevuljević, Milica Miljković, Mirko Kerkez, Vladimir Đorđević, Ljubomir Đurašić and Slađana Šobajić
Background: This study investigated the effects of a nutritionally relevant intake of eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids derived from oily fish or a fish oil supplement on selected cardiovascular risk factors in average middle-aged individuals.
Methods: Thirty-three participants were randomized to receive salmon (oily fish) providing 274 mg EPA + 671 mg DHA/day or a commercial fish oil supplement providing 396 mg EPA + 250 mg DHA/day in a cross-over trial over an 8-week period separated by a 6-month washout period. Blood samples were collected before and after each intervention and lipids, inflammatory and oxidative stress parameters were determined.
Results: Plasma levels of EPA, DHA and total n-3 fatty acids significantly increased after both interventions. A decreasing trend in triglycerides was more pronounced with salmon than with the fish oil supplement, but the changes noticed were not significant. Although there were no relevant changes in inflammatory marker concentrations at the end of both interventions, significant negative correlations were noticed between total plasma n-3 fatty acids and soluble intercellular adhesion molecule and Creactive proteinconcenthroughout the whole intervention period (p<0.05). Among the oxidative stress parameters, intervention with salmon showed a prooxidative effect through a superoxide anion increase (p=0.025). A relevant positive correlation was also found between its concentration and total plasma n-3 fatty acids (p<0.05). Other oxidative stress markers were not significantly influenced by the dietary interventions applied.
Conclusion: Following two sets of recommendations for n- 3 fatty acids intake aimed at the general public had only a moderate effect on the selected cardiovascular risk factors in average healthy middle-aged subjects over a short-term period
Iva Perovic Blagojevic, Tatjana Eror, Jovana Pelivanovic, Svetlana Jelic, Jelena Kotur-Stevuljevic and Svetlana Ignjatovic
Background: Polycystic ovary syndrome (PCOS) is associated with reproductive and metabolic abnormalities. The aim of this study was to analyse risk of cardiovascular disease (CVD) in PCOS, to define individual risk factors and assess their ability to predict risk.
Methods: Fifty-four young women with PCOS (22 obese and 32 normal weight) were compared to 46 respective controls (17 obese and 29 normal weight). Anthropometric parameters, lipid status parameters, inflammation markers, concentrations of glucose, transaminases, sex and anterior pituitary hormones, sex hormone binding globulin (SHBG) and androgens were measured. Cardiovascular Risk Score (CVRS), indices for identifying Non-Alcoholic Fatty Liver Disease (NAFLD) and the Index of Central Obesity (ICO) were calculated.
Results: Significantly higher CVRS values (p<0.05) were found in obese PCOS women compared to normal weight control and normal weight PCOS groups. Anthropometric parameters, lipid status parameters and fibrinogen (p<0.001, p<0.01) were higher in women with higher CVRS. The most significant CVRS predictors in all PCOS women were SHBG, androstenedione, follicle-stimulating hormone (FSH) and dehydroepiandrosterone sulphate (DHEAS). ICO and all NAFLD indices exhibited significant positive correlation with CVRS and a model consisting of these indices provided good diagnostic accuracy (AUC>0.8) in identifying patients with increased cardiovascular risk (CVR).
Conclusions: Obesity is a higher risk for developing CVD than PCOS alone. Anthropometric parameters, lipid parameters, fibrinogen, NAFLD indices and ICO increase CVR in PCOS women. For the prediction of CVR in PCOS, we suggest a combination of NAFLD indices and ICO.
Darko D. Dželajlija, Slavica S. Spasić, Jelena M. Kotur-Stevuljevic and Nataša B. Bogavac-Stanojevic
Background: Atherosclerosis is a chronic inflammatory disease which starts early in life and depends on many factors, an important one being dyslipoproteinemia. According to several studies, atherosclerotic plaques or their precursors could be seen in children younger than 10 years. During later life, interaction with a sedentary way of life, as well as unhealthy nutrition, smoking, alcohol consumption, obesity and family history of cardiovascular disease cause the burden of atherosclerotic disease.
Methods: Study included 624 children (316 boys, 308 girls), aged from 7-13 years. We analysed socio-demographic data (BMI, blood pressure, cardiovascular family history, smoking status), as well as lipid status with lipoprotein little a-Lp(a), and apolipoproteins: Apo AI, Apo B-100 for all children. This enabled us to calculate new atherogenic indices Tg/HDL-c, lipid tetrad index (LTI) and lipid pentad index (LPI). Cardiovascular risk for later life was estimated by using modified Risk Score for Young Individuals (RS), which divided the subjects according to the score level: low, medium and higher risk.
Results: The older children (13 y) had better lipid status than the younger children, i.e. significantly lower total cholesterol, LDL-C, triglycerides and non-HDL-C concentration and significantly higher HDL-C concentration than the younger children and this was in accordance with the RS level. Children with a positive family history of CV disease had significantly higher Lp(a) concentration and blood pressure. LPI was significantly higher in children with a higher RS.
Conclusions: The results of our work could be used for cardiovascular risk assessment in apparently healthy children to provide preventive measures which could control the change able risk factors.
Ana Ninić, Nataša Bogavac-Stanojević, Miron Sopić, Jelena Munjas, Jelena Kotur-Stevuljević, Milica Miljković, Tamara Gojković, Dimitra Kalimanovska-Oštrić and Vesna Spasojević-Kalimanovska
Coronary artery disease (CAD) is one of the most important causes of mortality and morbidity in wide world population. Dyslipidemia, inflammation and oxidative stress may contribute to disruption of endothelium structure and function, atherosclerosis and CAD. Our study was aimed to determine whether Cu/Zn superoxide dismutase (Cu/Zn SOD) and Mn superoxide dismutase (Mn SOD) gene expression could be modulated by oxidative stress in CAD patients.
This study included 77 CAD patients and 31 apparently healthy persons. Serum lipid levels, high sensitivity C-reactive protein (hsCRP), total antioxidant status (TAS) and thiobarbituric acid-reacting substances (TBARS) were measured. SOD isoenzymes gene expression was determined in peripheral blood mononuclear cells using quantitative polymerase chain reaction.
Mn SOD messenger ribonucleic acid (mRNA) levels were significantly lower in CAD patients than in controls (p=0.011), while Cu/Zn SOD mRNA levels did not change significantly between tested groups (p=0.091). We found significantly lower high-density lipoprotein-cholesterol (HDL-c) (p<0.001) and TAS (p<0.001) levels and significantly higher hsCRP (p=0.002) and TBARS (p<0.001) in CAD patients than in controls. There were significant positive correlations between TAS and Mn SOD mRNA (ρ=0.243, p=0.020) and TAS and Cu/Zn SOD mRNA (r=0.359, p<0.001). TBARS negatively correlated only with Cu/Zn SOD mRNA (ρ=-0.215, p=0.040). TAS levels remained independent predictor for Mn SOD mRNA levels (OR=2.995, p=0.034).
Results of this study showed that Mn SOD gene expression were decreased in CAD patients compared to controls and can be modulated by non-enzymatic antioxidant status in blood.
Danica Michalickova, Jelena Kotur-Stevuljevic, Milica Miljkovic, Nenad Dikic, Marija Kostic-Vucicevic, Marija Andjelkovic, Vladimir Koricanac and Brizita Djordjevic
A randomized, double-blind, placebo-controlled study was conducted, in order to evaluate if Lactobacillus helveticus Lafti® L10 (Lallemand Health Solutions, Montreal, Canada) supplementation during three months could influence oxidative markers in the population of elite athletes: triathletes, cyclists and endurance athletes. Twenty-two elite athletes were randomized to either placebo (n = 12) or probiotic (n = 10) groups. The probiotic group received 2x1010 colony forming units of Lafti® L10. Before and after the supplementation serum samples were collected. Markers of oxidative stress and anti-oxidative defense: superoxide dismutase (SOD), paraoxonase (PON), advanced oxidation protein products (AOPP), malondialdehyde (MDA), total antioxidant status, total oxidant status, pro-oxidant-antioxidant balance, oxidative stress index, bilirubin, uric acid and albumin were determined in serum. Parameters of lipid status, as well as susceptibility to copper-induced oxidation of LDL particles in vitro were also determined. There was a significant interaction effect for MDA (p = 0.039), with a decrease in MDA in the probiotic group only (p = 0.049). There was a significant interaction effect for AOPP (p = 0.037), with a significant decrease in the probiotic group (p = 0.045). Interaction effect for SOD was approaching to formal significance (p = 0.108) and the post-hoc test showed a significant decrease in the probiotic group (p = 0.041) only. A significant correlation between AOPP and SOD (p = 0.012, r = -0.40) was found in the probiotic group at the end of the study. PON1 activity was decreased in both the probiotic (p = 0.032) and placebo group (p = 0.035). No significant changes in the remainder of the evaluated parameters were noted. In conclusion, probiotic strain Lafti® L10 exerts certain antioxidant potential, but further research is needed.
Marija Anđelković, Ivana Baralić, Brižita Đorđević, Jelena Kotur Stevuljević, Nenad Radivojević, Nenad Dikić, Sanja Radojević Škodrić and Mirjana Stojković
Background: The purpose of the present study was to report and discuss the hematological and biochemical behavior of elite soccer players, in order to get more insight in the physiological characteristics of these sportsmen and to provide trainers and sports doctors with useful indicators.
Methods: Nineteen male soccer players volunteered to participate in this study. We followed the young elite soccer players during a competitive half season. Venous blood samples were collected between 9:00 and 10:00 a.m. after an overnight fast (10 h) at baseline, after 45 and 90 days and hematological and biochemical parameters were measured.
Results: Hemoglobin and hematocrit levels were significantly reduced over the observational period (p<0.05), but erythrocyte count and iron levels remained unchanged. Bilirubin and ferritin levels significantly increased in response to regular soccer training (p<0.05). We observed a significant decrease in muscle enzyme plasma activity during the 90 days study period. ANOVA analysis revealed a significant increase in the leukocyte and neutrophil counts (p<0.05), in parallel with a significant decrease in the lymphocyte count (p<0.05) after the observational period of 90 days.
Conclusions: Elite soccer players are characterized by significant changes in biochemical and hematological paramneueters over the half season, which are linked to training workload, as well as adaptation induced by the soccer training. Although the values of the measured parameters fell within the reference range, regular monitoring of the biochemical and hematological parameters is fundamental for the identification of a healthy status and related optimal performances by sport doctors and trainers and selection of a correct workload by trainers.
Mina Radovic, Suzana Bojic, Jelena Kotur-Stevuljevic, Visnja Lezaic, Biljana Milicic, Milos Velinovic, Radmila Karan and Sanja Simic-Ogrizovic
Cardiac surgery-associated acute kidney injury (CSA-AKI) frequently occurs in patients assessed as low-risk for developing CSA-AKI. Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1) and lactate are promising biomarkers of CSA-AKI but have not yet been explored in low-risk patients.
To evaluate urinary NGAL (uNGAL), KIM-1 and lactate as biomarkers of CSA-AKI in patients with low-risk for developing CSA-AKI.
This prospective, observational study included 100 adult elective cardiac surgery patients assessed as low-risk for developing CSA-AKI. UNGAL, KIM-1 and lactate were measured preoperatively, at the end of cardiopulmonary bypass (CPB) and 3, 12, 24 and 48 h later.
Fifteen patients developed CSA-AKI. Patients with CSA-AKI had significantly higher lactate but similar uNGAL and KIM-1 levels compared to patients without CSA-AKI. Unlike uNGAL and KIM-1, postoperative lactate was good biomarker of CSA-AKI with the highest odds ratio (OR) 2.7 [1.4–4.9] 24 h after CPB. Peak lactate concentration ≥ 4 mmol/L carried dramatically higher risk for developing CSA-AKI (OR 6.3 [1.9–20.5]).
Unlike uNGAL and KIM-1, postoperative lactate was significant independent predictor of CSA-AKI with the highest odds ratio 24 h after CPB.