Evaluation of Serum Insulin, Glucose, Lipid Profile, and Liver Function in β-Thalassemia Major Patients and Their Correlation With Iron Overload

Shams, Salman; Ashtiani, Mohammad Taghi Haghi; Monajemzadeh, Maryam; Koochakzadeh, Leili; Irani, Heshmat; Jafari, Fahimeh; Mohseni, Ameneh

doi:10.1309/lms0eoouzsii2bne

Cited by 20 publications

(15 citation statements)

References 35 publications

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“…This difference in finding is due to different trait studied; minor and major respectively. Our findings of hypocholesterolemia and hypertriglyceridemia in patients of beta thalassemia major were supported by other studies [28,29] .…”

Section: Discussionsupporting

confidence: 91%

Study of Serum Lipid Profile in Beta-Thalassemia Major Patients

Doshi¹,

Sutay²

2016

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Section: Discussionsupporting

confidence: 91%

Study of Serum Lipid Profile in Beta-Thalassemia Major Patients

Doshi¹,

Sutay²

2016

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“…It is likely that an elevated level of iron and ferritin causes iron toxicity in the liver and pancreas, as well as insulin dysregulation, due to hepatic and pancreatic dysfunction, which is most likely the cause of impaired glucose metabolism in patients with β-TM,47 as pancreatic iron deposition is an early event, and many patients initially have normal glucose metrics. Over time, iron-mediated oxidative stress triggers apoptosis, volume loss and fatty replacement, leading to pancreatic dysfunction 3 48…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Functions in Adolescents with Beta Thalassemia Major Could Predict Cardiac and Hepatic Iron Loading: Relation to T2-Star (T2*) Magnetic Resonance Imaging

Mokhtar

Ibrahim

Elbarbary

et al. 2016

Journal of Investigative Medicine

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The aim of this study is to assess the correlation between cardiac and hepatic T2* MRI findings with the endocrine and exocrine pancreatic functions in known patients with β-thalassaemia major (β-TM). A total of 50 adolescent patients with β-TM and 44 healthy controls were investigated via: serum amylase, lipase, triglyceride index, oral glucose tolerance test and T2* MRI, to assess iron content in the heart and liver. Diabetes was found in 20%, and 40% of patients had impaired fasting glucose (IFG). Cardiac T2* was less than 10 ms in 22% indicating heavy load with iron in cardiac tissues. There was a significant decrease in median serum amylase (63.5 vs 87.5 IU/L, p=0.003) and lipase (63 vs 90 IU/L, p=0.017) among patients in comparison with the control group. Patients with β-TM and diabetes had lower serum amylase (32 vs 68 IU/L), lipase (28 vs 79 IU/L), cardiac and hepatic T2* MRI (7 vs 25.5 ms; 3 vs 6 ms, p<0.001 for all) than those without diabetes. Similar results were found among patients with IFG when compared with others (p<0.001 for all). Cardiac and hepatic T2* were inversely correlated to triglyceride index (r=-0.376, p=0.014 and r=-0.475, p=0.001, respectively) and positively correlated to amylase (r=0.791 and r=0.790) and lipase (r=0.784 and r=0.783; p<0.001 for all). The endocrine and exocrine pancreatic functions might become an equivalent predictor to cardiac and hepatic iron overload, especially in countries where MRI is not available or where it is expensive. The early occurrence of these abnormalities warrants more intensive chelation therapy.

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“…β-thalassemia is a major public health problem in Egypt, where the carrier rate was 9%-10% [ 1 ]. The genetic disorder includes a wide variety of clinical phenotypes, ranging in severity from clinically silent heterozygous β-thalassemia to severe transfusion-dependent β-thalassemia major (β-TM) [ 2 ]. Patients with β-TM present clinically with severe transfusion-dependent anemia together with other related complications including endothelial and vascular dysfunctions, increased oxidative stress with subsequent atherosclerotic development and cardiovascular diseases [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Genetic Polymorphism of methylenetetrahydrofolate reductase C677T on Development of Hyperhomocysteinemia and Related Oxidative Changes in Egyptian β-Thalassemia Major Patients

et al. 2016

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Backgroundβ-thalasemia major (β-TM) patients often suffer from various vascular complications together with increased oxidative stress. Hyperhomocysteinemia (Hhcy) has been defined as a risk factor for these complications. Genetic polymorphism of methylenetetrahydrofolate reductase (MTHFR) C677T has been shown to cause Hhcy particularly in individuals with low B-vitamins. However, the status of homocysteine (hcy) in β-TM has not yet been adequately defined.AimTo evaluate the genetic polymorphism of MTHFR C677T among β-TM patients and its prospective contribution to Hhcy and related oxidative changes.Subjects and MethodsGenotyping for MTHFR C677T was done by PCR-RFLP technique. Plasma hcy, vitamin B12, folate, malondialdehyde (MDA), total antioxidant capacity (TAC), oxidized low density lipoprotein (oxLDL), total nitric oxide (NOx) and lipid profile were determined in 66 β-TM patients and 66 control subjects of matched age and sex.ResultsThe prevalence of MTHFR 677TT genotype was significant among β-TM patients (12%) compared to (3%) controls (OR = 4.9, 95%CI:1.2–24.2,P = 0.03). A strong association between Hhcy and MTHFR TT genotype was observed (OR = 7.7, 95%CI:2.8–20.9) where all β-TM patients with TT genotype were hyperhomocystienemic (≥ 15 μmol/l) and having sub-optimal folate level than those with CT or CC genotypes. Hyperhomocystienemic patients have suffered from increased oxidative stress characterized by significant increase in plasma MDA and oxLDL, and a significant reduction of plasma TAC and total NOx. Lipid profile of those patients was severely affected indicated by reduction in HDL and HDL/LDL and elevation in atherogenic index as compared with CC genotype. Other measured parameters were not significantly different among β-TM patients with different MTHFR genotypes.ConclusionThis study suggests that Egyptian β-TM patients with MTHFR 677TT genotype could be at increasing risk of developing Hhcy particularly with folate deficiency. This state of Hhcy may account potentially for most oxidative changes and atherogenic vascular complications frequently reported in β-TM patients.

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Evaluation of Serum Insulin, Glucose, Lipid Profile, and Liver Function in β-Thalassemia Major Patients and Their Correlation With Iron Overload

Cited by 20 publications

References 35 publications

Study of Serum Lipid Profile in Beta-Thalassemia Major Patients

Study of Serum Lipid Profile in Beta-Thalassemia Major Patients

Pancreatic Functions in Adolescents with Beta Thalassemia Major Could Predict Cardiac and Hepatic Iron Loading: Relation to T2-Star (T2*) Magnetic Resonance Imaging

Impact of Genetic Polymorphism of methylenetetrahydrofolate reductase C677T on Development of Hyperhomocysteinemia and Related Oxidative Changes in Egyptian β-Thalassemia Major Patients

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