s314 Poster Session 2

P1263 Lp (a) Concentrations in Obese Prediabetic Subjects ZORICA V. CAPAREVIC, Nada D. Kostic, Svetlana D. Jelic, Gradimir M. Bojkovic. Endocrinoloy, CHC Dr DMisovic, Belgrade, Serbia, Yugoslavia

Lp (a) is a independent risk factor for cardiovascular disease in non diabetic subjects, but its contribution to cardiovascular disease in subjects with impaired fasting glucose (IFG) remains a conflicting topic.The aim of the study was to establish whether IFG is associated with high levels of Lp (a). Design and methods: The group included 15 obese patients (58+5,9 years, BMI=37,7 + 4,3kg/m2) with verified IFG (according with new ADA diagnostic criteria).We analysed:fasting plasma glucose, lipid profiles and Lp(a). Measurement of serum total cholesterol, LDL-C, HDL.C, triglycerides were done with standard enzyme kinetic methods. Levels of Lp (a) were measured by nephelometric assays.The obtained results were compared to the results of the control group (15 healthy obese subjects of the same age and same BMI). Results: According to obtained results the levels of Lp (a) were increased more than 0,25g/L in 46% and more than 0,5Og/L in 13% of patients with IFG. In the control group levels of Lp (a) were increased more than 0,25g/L in 33% and more than 0,5Og/L in 7% of healthy subjects.We also found in group with IFG significantly increased levels of plasma total cholesterol, LDL-C, triglycerides and lower levels of HDL-C compared to the results of the control group. Conclusion:Increased plasma levels of Lp (a) can be as an additional, independent risk factor for future cardiovascular disease particulary relevant in subjects with impaired fasting glucose.

P1264 Impairment of Beta Cell Secretion Determines Lipid Profile in Severe Obesity BRUNO GELONEZE ‘, Jose C. Pareja*, Enrico M. Repetto’, Aline G. Costa’, Marcos A. Tambascia’ . ’ Endocrinology, Unicamp, Campinas, Se Brazil; 2 Gostrocirurgy, Unicamp, Campinas, SF: Brazil

Elevated rate of cardiovascular death among type 2 Diabetes Mellitus (DM) has been attributed to several risk factors as obesity, hypertension, dyslipidemia and insulin resistance. There is also a very high proportion of dyslipidemia among diabetic patients. The typical lipid abnormal- ity includes high levels of triglycerides combined with low levels of HDL-cholesterol. The role of insulin resistance and secretion on the pathofisiology of dyslipidemia is not fully understood. To study the rela- tionship of dyslipidemia and insulin action and secretion we have studied severe obese patients classified by oral G’IT. From the outpatients clinics of University of Campinas we select patients paired by age, BMI and high insulin resistance scores. Insulin resistance and the beta cell secretion capability were analysed by HOMA (Homeostasis Model Assessment) method. The following table can show our results:

Normal &~cose tolerance DM2

n 16 14 Age (yeas) 35.li7.1 43.9ztll.9 ns BMI (kg/mZ) 53.3f13.6 50.3ill.2 ns

Total colesterol (mg/dL) 190.8f41.7 232.1f57.4 p<O.Ol HDL-colesterol (mg/dL) 43.5ill.Z 37.4ztl3.2 p<O.Ol

Triglycerides (mg/dL) 131.5f62.2 228.1+109.9 p<O.Ol

HOMA-IR 17.5f6.0 18.1+7.2”s

HOMA-beta 875.8f236.6 310.8*328.0 p<O.Ol

We observed that high insulin resistance score per se do not determine the presence of dyslipidemia in severe obese patients, especially when there are a good beta cell function. We can also conclude that the inability in increasing insulin secretion, analysed by HOMA-beta, can determine the typical diabetic lipids abnormalities in severe obese patients.

P1265 Elevated Mglycerides Are Associated to Insulin Resistance (Evaluated by HOMA-la) in Normal and Over-Weight Subjects with Normal Glucose Tolerance ERMANNO MORO, Paola Alessandrini, Pietro Gallina, Margherita Pais, Gabriele Bittolobon. 2nd Department of Internal Medicine, Ospedale Civile, Venezia, Italy

To study whether plasma triglycerides and body weight affect insulin resistence, in subjects with normal glucose-tolerance, we retrospectively evaluated 890 subjects (age 13-78 years), who underwent an OGTT. For all the subjects (60%male) we calculated the HOMA-IR ((fasting IRI(mU/ml)x FBG (mmoliI)/22.5) an index of insulin resistance. Subjects were divided in normal weight (BMIt25) over-weight (25<BMI<30) and obese BMI>30). Data were analyzed both on the entire group by multiple regression analysis and by comparing HOMA-IR values in tertiles of triglycerides, by analysis of variance (ANOVA). Multiple regression anal- ysis showed a highly significant independent direct correlation between HOMA-IR and age (p=O.O4), triglycerides (both in absolute values and log- transformed: p= 0.00007 and p=OOOO3 respectively) and BMI (p=3.OE-21) and an inverse indipendent association with HDL-C (p=O.O07). Total and LDL-C had no relation to HOMAIR. Subjects in the lower tertile of triglycerides levels (24-81 mg/dl) had a significantly lower HOMA-IR, as compared to the upper 2 tertiles and also a significant difference was observed between the upper 2 tertiles (data are reported in the table).

Normal-weight

1 tenile triglycerides 1.69 i 0.65

II tenile triglycerides 2.10 zk 1.25

111 &tile triglycerides 2.50 + 2.15

ANOVA: * = p<O.OOl; ** = pcO.0001

Over-weight Obese

2.26 + 1.04 3.14 f 2.08

2.60 i 1.43 3.34 i 1.41

3.22 f 1.64 5.29 % 5.43

Triglycerides levels are associated to insulin resistance as measured by HOMA-IR both in normal-weight subjects than in over-weight and obese subjects with normal glucose tolerance. HDL-C is inversely and inde- pendently predictive of insulin resistance by multiple regression analysis, while total and LDL-C do not interact with insulin activity, as measured by HOMA-IR.

P1266 Plasma Triglyceride Levels Decrease in NIDDM Subjects When Consuming High Fat, Low Carbohydrate Intakes M.T. CLANDININ, J. Jumpsen, E.A. Ryan, M.A. French, Y.K. Goh.

Objective: To examine the effects of an increase in fat and decrease in carbohydrate intake on plasma triglyceride levels and VLDL triglyceride synthesis in normal subjects and subjects with NIDDM. Methods: Patients treated for NIDDM and control subjects were examined after 3 dietary treatment periods of 3 months each. Control subjects were gender and age-matched (zk 2 yrs) to this group of NIDDM individuals. Treatment periods required consumption of a high CHO (> 50% energy) and low fat (~30% energy) diet compared to a high fat diet providing increase in monounsaturated fat intake of up to 10% of energy above that of the low fat treatment period. During the last week of each treatment pe- riod, a 7-day food record was collected. During the last day of this dietary record DzO was consumed to measure VLDL TG synthesis over a 24-hr. period. Fasting blood samples were collected for measurement of blood lipids, glycemic control and deuterium incorporation into the VLDL TG. Results: Results indicate a reduction in plasma TG level and cholesterol fractional synthesis rate for subjects achieving the high fat, low CHO intake in comparison to the treatment period providing a high carbohydrate low fat intake. Conclusion: Increasing the fat level with monounsaturated fatty acid, in NIDDM subjects consuming a high CHO, low fat diet reduces plasma TG levels.