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Elevated WBC count, even within the normal range, is associated with both macro- and microvascular complications in type 2 diabetes. Chronic inflammation, as indicated by a higher WBC count, may play a linkage role in the development of macro- and microvascular complications in diabetes.

OBJECTIVE: Visceral fat, notably mesenteric fat, which is drained by the portal circulation, plays a critical role in the pathogenesis of metabolic syndrome through increased production of free fatty acids, cytokines and vasoactive peptides. We hypothesize that mesenteric fat thickness as measured by ultrasound scan could explain most of the obesity-related health risk. We explored the relationships between cardiovascular risk factors and abdominal fat as determined by sonographic measurements of thickness of mesenteric, preperitoneal and subcutaneous fat deposits, total abdominal and visceral fat measurement by magnetic resonance imaging (MRI) and anthropometric indexes. DESIGN: A cross-sectional study. SUBJECTS: Subjects included 18 healthy men and 19 women (age: 27-61 y, BMI: 19-33.4 kg/m 2 ). MEASUREMENTS:The maximum thickness of mesenteric, preperitoneal and subcutaneous fat was measured by abdominal ultrasound examination. MRI examinations of whole abdomen and pelvis were performed and the amount of total abdominal and visceral fat was quantified. The body mass index, waist circumference and waist-hip ratio were recorded. Cardiovascular risk factors were assessed by physical examination and blood taking. RESULTS: Men had more adverse cardiovascular risk profile, higher visceral fat volume and thicker mesenteric fat deposits than women. Among all the investigated obesity indexes, the mesenteric fat thickness showed the highest correlations with total cholesterol, LDL-C, triglycerides, fasting plasma glucose, HbA 1c and systolic blood pressure in men, and with triglycerides and HbA 1c in women. On stepwise multiple regression analysis with different obesity indexes as independent variables, 30-65% of the variances of triglycerides, total cholesterol, LDL-C and HbA 1c in men, and triglycerides in women were explained by the mesenteric fat thickness. CONCLUSION: Compared with sonographic measurement of subcutaneous and preperitoneal fat thickness, MRI measurement of total abdominal and visceral fat and anthropometric indexes, sonographic measurement of mesenteric fat thickness showed better associations with some of the cardiovascular risk factors. It may potentially be a useful tool to evaluate regional distribution of obesity in the assessment of cardiovascular risk.

The effect of biphosphonate therapy on bone mineral density (BMD) in patients with primary hyperparathyroidism (PHP) is unknown. Forty postmenopausal women (mean age, 70 yr) with PHP were randomized to receive alendronate 10 mg/d or placebo for 48 wk, followed by treatment withdrawal for 24 wk. The mean (+/-SD) changes in BMD at femoral neck (+4.17 +/- 6.01% vs. -0.25 +/- 3.3%; P = 0.011) and lumbar spine (+3.79 +/- 4.04% vs. 0.19 +/- 2.80%; P = 0.016) were significantly higher with alendronate at 48 wk. Serum calcium was reduced with alendronate but not placebo (-0.09 vs. +0.01 mmol/liter; P = 0.018). Serum bone-specific alkaline phosphatase activity was lower with alendronate from 12 wk onward and increased 24 wk after treatment withdrawal (21.1 +/- 12.8 to 7.3 +/- 4.9 IU/liter at 48 wk, and 15.0 +/- 14.8 IU/liter 24 wk after withdrawal; P = 0.002 for trend). Osteocalcin concentration decreased at 48 wk and increased 24 wk after alendronate withdrawal (P = 0.019 for trend of change over time) but not with placebo. Urinary N-telopeptide/creatinine ratio decreased with alendronate at 48 wk and increased 24 wk after treatment withdrawal (P = 0.008 for trend). N-telopeptide/creatinine ratio did not change with placebo. Alendronate improves BMD and reduces bone turnover markers in postmenopausal women with PHP.

OBJECTIVE -Mesenteric fat, a reflection of visceral adiposity, may play an important role in the pathogenesis of metabolic syndrome and cardiovascular diseases (CVD). In this study, we examined the independent relationship between mesenteric fat thickness and metabolic syndrome and defined its optimal cutoff value to identify high-risk subjects for metabolic syndrome and CVD. RESEARCH DESIGN AND METHODS -A total of 290Chinese subjects had an ultrasound examination for measurements of thickness of mesenteric, preperitoneal, and subcutaneous fat as well as carotid intima-media thickness (IMT). Anthropometric measurements and metabolic risk profile were assessed by physical examination and blood taking.RESULTS -Twenty (6.9%) subjects had metabolic syndrome according to the National Cholesterol Education Panel Adult Treatment Panel III criteria with Asian definitions for central obesity (waist circumference Ͼ80 cm in women and Ͼ90 cm in men). Mesenteric fat thickness had significant correlations (P Ͻ 0.05) with various metabolic variables. On multivariate regression, mesenteric fat thickness was an independent determinant of all components of metabolic syndrome after adjustment for age, sex, homeostasis model assessment of insulin resistance, and other fat deposits. The odds ratio of metabolic syndrome was increased by 1.35 (95% CI 1.10 -1.66)-fold for every 1-mm increase in mesenteric fat thickness. On receiver-operating characteristic curve analysis, mesenteric fat thickness of Ն10 mm was the optimal cutoff value to identify metabolic syndrome, with sensitivity of 70% and specificity of 75%. Subjects with mesenteric fat thickness Ն10 mm had higher carotid IMT than those with thickness Ͻ10 mm (0.73 Ϯ 0.19 vs. 0.64 Ϯ 0.16 mm, P ϭ 0.001).CONCLUSIONS -Mesenteric fat thickness was an independent determinant of metabolic syndrome and identified subjects with increased carotid IMT. Diabetes Care 29:379 -384, 2006M etabolic syndrome is a constellation of multiple risk factors including hypertension, dysglycemia, dyslipidemia, and central obesity (1). Subjects with metabolic syndrome have a two-to threefold increased risk for cardiovascular diseases (CVDs) (2). There is ongoing debate regarding the relative roles of insulin resistance (1) and visceral adiposity in its pathogenesis (3). In this regard, there is a wealth of data showing the intimate relationships between visceral adiposity and adverse lipid profile (4), insulin sensitivity (5), elevated blood pressure (6), and impaired glucose tolerance (7).Visceral adipose tissue, particularly mesenteric fat, is metabolically more active than subcutaneous or extraperitoneal fat (8). Carr et al. (3) recently reported independent relationships between intraabdominal fat as measured by single-slice computed tomography and all components of metabolic syndrome. However, the relative contributions of different deposits of visceral fat remain uncertain. We hypothesized that these independent relationships were mainly attributable to mesenteric fat that directly drains into portal ...

Up to 70% of the Chinese Type 2 diabetic outpatients have GI symptoms, which is a much higher rate than in non-diabetic control subjects. Duration of diabetes is the most important factor associated with the presence of such GI symptoms.

H. pylori infection protects against the development of GERD, and carditis is unlikely to play an important role.

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