| 51. |
- Ahrén, Bo, et al.
(author)
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Signals adapting the beta cells to changes in insulin sensitivity
- 2003
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In: The metabolic syndrome: diabetes, obesity, hyperlipidemia and hypertension. Proceedings of the 8th European Symposium on Metabolism. - 0531-5131. ; 1253, s. 105-113
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Conference paper (peer-reviewed)abstract
- Insulin sensitivity and secretion are related in a curvilinear inverse asymptotic function. However, the signaling factors mediating this relation are not known. In this study, we explored whether circulating glucose, lipids or two adipocyte-derived hormones, leptin and adiponectin, are related to the curvilinear function between insulin sensitivity and secretion in subjects with normal glucose tolerance. Thereby, insulin secretion (2-5-min insulin response to intravenous arginine) and insulin sensitivity (euglycemic, hyperinsulinemic clamp) were established in 68 healthy women, aged 61 years. We confirmed the curvilinear relation between insulin sensitivity and insulin secretion (r = -0.71, P < 0.001). To quantify the ability of the beta cells to secrete insulin for balancing a change in insulin sensitivity, we introduce the beta cell compensation index (BCI) by dividing insulin secretion by insulin sensitivity. This index correlated significantly with circulating triglycerides, leptin and adiponectin as well as BMI, but not fasting or 2-h glucose. A multivariate stepwise regression analysis using these variables as independent variables and lg BCI as the dependent variable revealed that leptin (r = 0.54, P < 0.001) and adiponectin (r = -0.33, P = 0.008) independently contributed to lg BCI (R-2 of the model = 0.19m, P = 0.038). The study, therefore, suggests that adipocyte-derived hormones contribute to the beta cell compensation to insulin resistance. (C) 2002 Elsevier Science B.V. All rights reserved.
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| 52. |
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| 53. |
- Akerstedt, T, et al.
(author)
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Sleep as restitution: an introduction.
- 2003
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In: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 254:1, s. 6-12
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Journal article (peer-reviewed)
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| 54. |
- Andersson, S E, et al.
(author)
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Cutaneous vascular reactivity is reduced in aging and in heart failure: association with inflammation
- 2003
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In: Clinical Science. - 1470-8736. ; 105:6, s. 699-707
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Journal article (peer-reviewed)abstract
- In the present study, we have investigated whether changes in vascular reactivity in congestive heart failure (CHF) patients can be detected in the cutaneous microvessels and whether these changes are due to endothelial dysfunction, are affected by increasing age and related to an ongoing inflammation. The responses to local warming and iontophoretically administered endothelium-dependent and -independent vasodilators were investigated in healthy young adults, healthy elderly adults and elderly adults with CHE The results were correlated with plasma concentrations of vascular risk factors and markers for endothelial dysfunction and inflammation. The vasorelaxant responses were reduced in the elderly groups and were attenuated further in the CHF group. This group also had increases in levels of several markers associated with inflammation, higher blood glucose and homocysteine levels, a lower low-density lipoprotein-cholesterol and a rise in the concentration of von Willebrand factor, indicating a prothrombotic endothelial function. The severity of the heart failure, measured as the plasma level of brain natriuretic peptide, correlated with the intensity of inflammation and to the changes in vascular risk factors and endothelial function. It is concluded that the reactivity of the cutaneous microvessels is reduced with age, and the presence of CHF causes a further impairment. There is endothelial dysfunction in CHF, but it is uncertain to what extent this contributes to the reduced vasodilatory capacity. The inflammatory response appears central for many of the manifestations of the CHF syndrome.
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| 55. |
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| 56. |
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| 57. |
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| 58. |
- Bingham, SA, et al.
(author)
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Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study
- 2003
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In: The Lancet. - 1474-547X. ; 361:9368, s. 1496-1501
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Journal article (peer-reviewed)abstract
- Background Dietary fibre is thought to protect against colorectal cancer but this view has been challenged by recent prospective and intervention studies that showed no protective effect. Methods We prospectively examined the association between dietary fibre intake and incidence of colorectal cancer in 519 978 individuals aged 25-70 years taking part in the EPIC study, recruited from ten European countries. Participants completed a dietary questionnaire in 1992-98 and were followed up for cancer incidence. Relative risk estimates were obtained from fibre intake, categorised by sex-specific, cohort-wide quintiles, and from linear models relating the hazard ratio to fibre intake expressed as a continuous variable. Findings Follow-up consisted of 1939 011 person-years, and data for 1065 reported cases of colorectal cancer were included in the analysis. Dietary fibre in foods was inversely related to incidence of large bowel cancer (adjusted relative risk 0.75 [95% CI 0.59-0.95] for the highest versus lowest quintile of intake), the protective effect being greatest for the left side of the colon, and least for the rectum. After calibration with more detailed dietary data, the adjusted relative risk for the highest versus lowest quintile of fibre from food intake was 0.58 (0.41-0.85). No food source of fibre was significantly more protective than others, and non-food supplement sources of fibre were not investigated. Interpretation In populations with low average intake of dietary fibre, an approximate doubling of total fibre intake from foods could reduce the risk of colorectal cancer by 40%.
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| 59. |
- Björk, Jan, et al.
(author)
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Sporadiska kolorektala polyper. Uppdaterade riktlinjer for endoskopikontroller
- 2003
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In: Läkartidningen. - 0023-7205. ; 100:34, s. 2584-2584
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Journal article (peer-reviewed)abstract
- No surveillance is recommended after radical excision of low-risk adenomas (pedunculated adenoma irrespective of size, sessile adenoma < or = 10 mm, number < or = 2. An endoscopic check-up is recommended 3-6 months after radical excision of high-risk adenomas (sessile adenoma > 10 mm, number > or = 3), as well as after excision of a pedunculated or a sessile adenoma with an unclear resection margin. All above is irrespective of histopathological adenoma classification. An endoscopic check-up is recommended 3 months after radical excision of a highly or moderately differentiated malignant polyp with no sign of invasion into blood or lymph vessels and with a maximum invasion depth stage T1-sm1. Surgical resection is necessary if the malignant polyp is poorly differentiated, and/or invades into blood or lymph vessels, and/or is stage T1-sm3, or is excised with unclear resection margins. Treatment for stage T1-sm2 polyps may be individualized. Individuals with low-risk adenomas and a first degree relative with colorectal cancer, individuals having high-risk adenomas or malignant polyps removed, as well as individuals operated on for colorectal cancer should be subjected to colonoscopy after three years and then every fifth year when < or = 75 years of age.
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| 60. |
- Bülow, B, et al.
(author)
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Adrenal incidentaloma - experience of a standardized diagnostic programme in the Swedish prospective study.
- 2002
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In: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 252:3, s. 239-246
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Journal article (peer-reviewed)abstract
- Bülow B, Ahrén B (Lund University, Lund, Sweden) on behalf of the Swedish Research Council Study Group of Endocrine Abdominal Tumours. Adrenal incidentaloma - experience of a standardized diagnostic programme in the Swedish prospective study. J Intern Med 2002; 252: 239-246. OBJECTIVE: To report the 5-year experience of a diagnostic programme for adrenal incidentaloma with special emphasis to diagnose hormonally active and malignant lesions. DESIGN: A prospective study in which new cases of adrenal incidentalomas in Sweden have been evaluated by a standardized diagnostic protocol between January 1996 and July 2001. SETTING: Thirty-three different Swedish hospitals have contributed with cases. SUBJECTS: A total of 381 patients (217 females, 164 males) with adrenal incidentalomas were studied. INTERVENTIONS: Diagnostic procedures were undertaken according to a standardized programme. Operation was recommended if the incidentaloma had a size of more than 3-4 cm or if there was a suspicion of a hypersecreting tumour. MAIN OUTCOME MEASURES: The size of the incidentaloma, clinical characteristics of the patients and results of biochemical diagnostic tests were registered. RESULTS: The median age of the patients was 64 years (18-84 years), and the median size of the incidentalomas was 3 cm (1-20 cm). A total of 85(22%) patients were operated. Twenty of thesepatients were diagnosed with a benign hypersecreting tumour and 14 with a malignant tumour. Fourteen of 15 operated patients with diagnosed pheochromocytoma had elevated 24-h urinary noradrenaline and all of the patients operated because of a biochemical suspicion of aldosterone or cortisol hypersecretion (n = 6) were found to have adrenal adenomas. Of the 14 operated patients with malignant diseases, 10 were adrenal carcinomas (median size 10 cm; range 4-16 cm). In a multiple logistic regression model, incidentaloma size was significantly associated with the risk of a malignant tumour (P = 0.009), and there was a tendency of an association between age/male sex and the risk of a malignancy (both, P = 0.07). CONCLUSION: In this Swedish multicentre study of 381 cases with adrenal incidentalomas, 5% had benign hypersecreting tumours and nearly 4% had malignant tumours. The results of the biochemical diagnostic tests used had a high compatibility with the histological diagnosis found at operation in the patients with hypersecreting tumours. Tumour size, male gender and high age were predictive for the risk of a malignant tumour. A follow-up of the patients is warranted in order to establish whether there are undiscovered cases of malignant or hypersecreting tumours amongst the nonoperated patients.
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