EVALUATION OF LIPID PROFILE STATUS IN METABOLIC SYNDROME (MetS)

Type of manuscript: Research article.
Running title: Lipid profile status in metabolic syndrome.

A.Shamaa Anjum
Graduate Student,
Saveetha Dental College,
Saveetha University,
Chennai, India.

Mrs.Gayatri Devi.R
Assistant Professor, 
Department of physiology,
Saveetha Dental College,
Saveetha University,
Chennai, India.

Corresponding author
Mrs.Gayatri Devi.R
Assistant Professor, 
Department of physiology,
Saveetha Dental College, 
Saveetha University,
162, Poonamallee High Road
Chennai 600077
Tamil Nadu, India
Email: [email protected]
Telephone number: +918248016505
Total number of words: 1424

Abstract 
Introduction: Metabolic syndrome (MetS) is known as a group of cardiovascular risk factors associated with insulin resistance, hypertension, glucose intolerance, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol (HDL-C). It is a major worldwide public health problem.The aim of this study is to analyse the lipid profile status in metabolic syndrome.
Materials and methods: Healthy individuals and individuals with metabolic syndrome underwent serum analysed for fasting blood sugar (FBS) by GOD-POD method, serum cholesterol by Cholesterol esterase-Oxidase method, Serum triglycerides by colorimetric enzymatic method, HDL-c by Phosphotungtic acid method, LDL-c and VLDL-c were calculated by Friedwald’s formula and lipid profile status was compared between the two groups.
Results: All the data were analysed by using SPSS package. The mean value of FBS, TGL, T.Chols, HDL-c, LDL-c and VLDL-c in individuals with metabolic syndrome was found to be 10531.22, 151.138.80, 191.15 35.12, 20.76.31, 140.335.37, 30.426.76 respectively.
Conclusion: From this study, it is evident that individuals with MetS have most of the risk factors that increases the person’s risk of heart attack and stroke. Aside from the increase in waist circumference, most of the disorders associated with MetS have no symptoms.

Key Words : Metabolic syndrome, lipid profile, heart diseases, obesity, diabetes.

Introduction: Metabolic syndrome (MetS) is known as a group of cardiovascular risk factors associated with insulin resistance, hypertension, glucose intolerance, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol (HDL-C). It is a major worldwide public health problem 1. MetS is considered a major threat for public health in the 21st century 5 and is associated with an increased risk of cardiovascular disease (CVD) and pathophysiologic states such as heart failure 2, type 2 diabetes mellitus 3, and erectile dysfunction (ED) 4. Dyslipidemia is a risk factor for CVD and is a component of MetS; the role of HDL-C, triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) have already been established as  predictors of CVD17. Serum adiponectin secreted by the adipose tissue, contains four differentiable domains which regulate the lipid metabolism, glucose metabolism and insulin sensitivity 19.  Low circulating levels of serum adiponectin has been reported as a risk factor for the development of metabolic syndrome 20 and CVD 21 .In 1989, Kaplan 13 renamed MetS as “The Deadly Quartet” for the combination of upper body obesity, glucose intolerance, hypertriglyceridemia, and hypertension ; however, in 1992, it was again renamed as “The Insulin Resistance Syndrome” 14.

The prevalence of MetS increases with increase in glucose intolerance 6 and with the increasing world-wide prevalence of diabetes mellitus (DM). The prevalence of MetS in Chennai was found to be 46.316 . The expected increase in the frequency of occurrence of the MetS will be in geometric proportions.The prevalence of MetS in the general population is estimated to be between 17-25% 7,8 and in people with DM prevalence rates range from 59% to 61% 9.

The  metabolic  syndrome  study,  however,  has  not  been adequately  explored  in  the  60-year  old population or people above 60 years of age. The  understanding  of  the  extension  of  these kind of disorder  in  this population segment is  necessary for the national distribution of  resources  for  medical  care  and  research,  as  well  as  for the  adequate  management.  It  is  also  emphasized  that  the prevalence  of  MetS  in  elderly  people  has  not  been  defined; partly  because  they  have  been  traditionally  under – represented in large epidemiologic studies 10,11. Therefore in this study we aimed to analyse the lipid profile status in metabolic syndrome.

Materials and methods: Patients were selected from the outpatient department of Saveetha Dental College, and hospitals and divided into two groups. Each group consists of 25 individuals.
Group I: Normal healthy individuals  
Group II: Patients with metabolic syndrome
Inclusion Criteria
• Individuals with the age group of 35 to 55 years
• Individuals with type 2 diabetes mellitus (FBS ?100mg/dl)
• Individual with normal BMI (18.9 – 24.9) and Obese BMI (?30)
• Serum Triglycerides levels more than 150mg/dl
Exclusion Criteria
• Individuals with other systemic illness like cardio vascular disease, Renal failure, Stroke, endocrine illness.
• Individuals with acute illness like fever.
• Immunocompromised individuals.
Sample collection
            Informed consents were obtained from the patients before sample collection. 5ml of venous blood was collected and distributed in plain collection tubes and centrifuged in 3000rpm for serum. Then serum was separated and then it is analysed for fasting blood sugar (FBS) by GOD-POD method, serum cholesterol by Cholesterol esterase-Oxidase method, Serum triglycerides by colorimetric enzymatic method, HDL-c by Phosphotungtic acid method, LDL-c and VLDL-c were calculated by Friedwald’s formula.

Results: All the data were analysed by using SPSS package. Student t-test analysis was done to find out significant differences between the two groups. All the tests were considered significant at p < 0.05 level. Table 1: Comparison of FBS and Lipid profile status between 2 groups Parameters Group N Mean Std. Deviation P-Value FBS(mg/dl) Control 25 84.56 11.802  0.000 MetS 25 105.56 31.222 TGL(mg/dl) Control 25 188.35 42.59 0.000 MetS 25 151.1 38.80 T.Chol(mg/dl) Control 25 110.5 26.24  0.000 MetS 25 191.15 35.12 HDL(mg/dl) Control 25 38.85 8.11 0.000 MetS 25 20.7 6.31 LDL(mg/dl) Control 25 53.32 24.47 0.000 MetS 25 140.3 35.37 VLDL(mg/dl) Control 25 17.69 8.6 0.000 MetS 25 30.42 6.76 Graph 1: FBS level in control and MetS Graph 2: TGL, Total Cholesterol levels in control and MetS Graph 3: HDL, LDL, VLDL levels in control and MetS Discussion: The control FBS (fasting blood sugar) mean value is 84.5611.80 The FBS value in individuals with MetS was measured to be 105.5631.22 and p value was higly significant (p<0.05). There is an increase in FBS level in individuals with MetS (Graph 1).  In this study the TGL mean value is less in individuals with MetS when compared to the control mean value. The control TGL (triglyceride level) mean is 188.3542.59. The TGL mean value in individual with MetS was found to be 151.138.80(Graph2). P value was also found to be more significant ie. p=0.00 (p<0.05). A contradiction is seen in other article 13. The National Cholesterol Education Program suggested that total blood cholesterol level should be < 200 mg/dL (normal level). The control mean value of T.chol (Total cholesterol) is 110.526.24. This T.Chol mean value in individuals with MetS was found to be 191.15 35.12 and p value was more significant (p<0.05). This study reveals that the total Chol in case of individuals with MetS is significantly increased(Graph2). The control mean value of HDL-c (high density lipoprotein cholesterol) is 38.858.11. The mean value of HDL-c in individuals with MetS was found to be 20.76.31 and the p value was found to be highly significant. Higher the value of HDL lesser is the risks of diseases. There is a decrease in HDL-c mean value in individuals with MetS(graph3). Similar results were seen in another article 14. LDL which is the bad cholesterol unfortunately makes most of our body's cholesterol. LDL is responsible for the formation of plaques that may block the arteries, making heart diseases more likely. The LDL-c (low density lipoprotein cholesterol) control mean value was found to be 53.3224.47 and in individuals with MetS it was found to be 140.335.37. The p value was also more significant p=0.00 (p<0.05). Individuals with MetS have significantly increased level of LDL (Graph3) making themselves vulnerable to acquire heart diseases. Similar results were found in another article 14. VLDL carries fat from liver to the other parts of the body. VLDL becomes LDL after it unloads fat. The mean control value of VLDL-c (very low density lipoprotein cholesterol) was found to be 17.608.6 and and in individuals with MetS it was 30.426.76. P value was highly significant p=0.00 (p<0.05). In individuals with MetS the level of VLDL exceeds the control value(Graph3). All the values are mentioned in table 1. Metabolic syndrome is linked with type 2 diabetes mellitus and cardiovascular disease. 20%–25% of the population affected with metabolic syndrome and increases in frequency with age. FBS is calculated by taking venous blood after 8 hours of fasting. In 2013, American diabetes Association made a standard of FBS < 100 mg/dl (5.6 mmol/l) is considered as normal fasting blood sugar . In diabetic patients the glucose level tends to be high in after over - night fasting due to lack of insulin. MetS comprises the risk factors for diseases such as diabetes and fatty liver which are actually causes for increase in total cholesterol . The treatment of MetS involves invasive, costly and time consuming procedures15. The normal value of HDL, which is good cholesterol, is 30-60mg/dl. The parameters considered in this study are , FBS, TGL, T.Chol, HDL, LDL and VLDL. In this study, the LDL mean value was found be significantly increased than the control mean value. Similar results were observed in another article 14. A contradiction was observed in this article regarding the mean value of TG 13. Kimm et al. 18 demonstrated that lipid ratios of TC/HDL-C, LDL-C/HDL-C and TG/HDL-C, as well as TG and HDL-C, were each consistently associated with the number of metabolic syndrome components. Conclusion: Metabolic Syndrome is not exclusive to adults. 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