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trafic.ro Scientific Works, Adrian Copcea, MD, Nutrition-Diabetes | Nutritionist Cluj

Scientific works, A.Copcea, MD

—partial list of published abstracts—

 EVALUATION OF THE NUTRITIONAL STATUS AND ITS RELATIONSHIP WITH THE POPULATION METABOLIC DISEASES
Authors: Adrian Copcea, Madalina Tamas, Andreea Baciu, Dana Simu

Introduction. The evaluation of the nutritional status is an efficient and pathognomonic method to identify the nutrition-related conditions at a population level, followed by the diagnosis and the specific therapeutic approach. The term “population metabolic diseases” refers mainly to 4 conditions: diabetes mellitus, obesity, dyslipidemia and metabolic syndrome, which are present in the general population at an epidemic level. For their identification, an important instrument is, along with others, the evaluation of the nutritional status, which consists in the assessment of the degree in which the physiological nutritional needs are satisfied or overleaped.  Methods: We assesed the nutritional status of a group of 90 patients which presented to the Ambulatory of the Clinic for Diabetes, Nutrition and Metabolic Diseases in Cluj. The evaluation consisted in anamnesis, anthropometrical measurements, clinical examination, laboratory determinations, nutritional retrospective questionnaire, and the analysis of food intake, from qualitative and quantitative point of view. Furthermore, we estimated the intake of macro- and micronutrients in each case, (using a database with the composition of foods, and an Excel application developed by us in this purpose) and we looked for the correlations between the food intake pattern and the nutrition recommendations (from the ADA guidelines 2005), and links with the associated pathology. The participants were 29 males and 61 females, aged between 19 and 67, with an average of 31.8 years of age. Results: Within the group, the average BMI was 27.9 kg/m2, the average weight was 87.9 kg in males and 73.9 in females. Overweight and obesity were present in 66.6% of the group, diabetes mellitus (type 1 and type 2) in 32.2%, metabolic syndrome (according to IDF criteria, 2005) in 58.8%, and impaired lipid profiles in 84.4%. The food consumption analysis  found an average daily energy intake of 2534 kcal in males and 1925 kcal in females, structured, as an average for the whole group, as follows: 16% protein, 43% fat (75% from animal sources and 25% vegetal fat), 41% carbohydrate. The average daily individual intake of micronutrients in this group was of 643 mg of calcium, 277 mg of magnesium, 25 mg of iron, 3.1 g of potassium, 1.01 g of sodium (excluding added salt, after preparation). The average daily vitamin consumption was of 1293 International Units of A vitamin, 123 mg of C vitamin, 54 International Units of D vitamin. In only 3% of the cases we reported a nutritional pattern consistent with the actual nutritional recommendations for the qualitative and quantitative structure of food intake. Conclusions: The average calcium and magnesium consumption is less then half of the recommended intake. The average amount of iron consumed by the participants is much smaller than the lower threshold of the nutritional recommendations for all age groups. The overall evaluation of the nutritional status of the studied group revealed a discordance between the nutrient intake and the actual nutritional recommendations (e.g. 75% of the fat intake was of animal origin in the group), which can explain, at least in part, the high frequency of the population metabolic conditions within the studied group.

A RARE TYPE OF DIABETES: WOLFRAM SYNDROME. A CASE REPORT
Authors: Adrian Copcea, Ilinca Lenta, Dominique Paris, Jean Frederic Blickle

BACKGROUND AND AIMS: Wolfram syndrome, also known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, Deafness), is a rare hereditary neurodegenerative disorder, consisting typically of the conditions quoted in the acronym, but also of urodynamic, neurological and psychiatric abnormalities. The association: diabetes mellitus – bilateral optical atrophy in children is sufficient for positive diagnosis. The disease affects males and females with the same frequency, the treatment is symptomatic and the prognosis is reserved, the death occurs usually at the age of 30-35, due in the majority of cases to neuropsychiatrical or urological complications. This is a case report of a Wolfram syndrome in an adult admitted for uncontrolled diabetes in the Diabetology Unit of the Centre Hospitalier Universitaire de Strasbourg, France. CLINICAL CASE:   Male patient, born in 1978, of Algerian origin, having a history of consanguinity in the family, was diagnosed in 1986 (at age 7) with Wolfram syndrome, having at the time of diagnosis diabetes mellitus, diabetes insipidus and a loss of visual acuity. Insulin therapy and treatment with desmopresin were initiated. In the following years, the patient presented a progressive hearing loss, needing bilateral hearing device in 2002; and a bladder atony of central origin, requiring intermittent self-catheterization since the age of 20. Total loss of sight was recorded in 2000, by bilateral atrophy of the optic nerve. In the medical file of the patient are also mentioned frequent decompensations of his diabetes including a ketoacidosis; hypothyroidism (2000), frequent urinary infections, and a tricuspid regurgitation (2006). The genetic diagnosis was realized in 2004, the patient being homozygote for the mutation 1775-1776delTG in WFS1 gene (chromosome 4). The patient is hospitalized for metabolic stabilization, the HbA1c level of 11.5%. At admission, the treatment consists of basal-bolus insulin therapy (glargin 16 UI per day, lispro 8 UI per day), desmopresin, and self-catheterization, 4 times a day. Clinically, the patient has normal vital signs, normal BMI, a rotatory nystagmus, blindness, unreactive pupils, mydriasis. The superior functions are preserved. He has microalbuminuria 58 mg/24 hours. The frequent urinary infections, and an inappropriate adjustments of insulin doses explain, at least partially, the poor metabolic control. The practical approach is an increase in insulin doses, and an urological education having as purpose a limited occurrence of urinary tract infections. DISCUSSIONS: In Western Europe, a few series of Wolfram Syndrome patients are reported. The illness is autosomic-recessive inherited, often due to consanguinity, as in the presented case. There are only few correlations between clinical features and genetic abnormalities. The diabetes mellitus within Wolfram syndrome is a non-autoimmune, juvenile-onset, insulin-dependent diabetes. A recent study conducted in France on a series of 26 patients found that insulin requirements are smaller, the metabolic control is better and the microvascular complications are less frequent in patients suffering from Wolfram syndrome than in type 1 diabetic pairs.

FOOD INTAKE PATTERNS IN ROMANIA: ARE WE HALFWAY BETWEEN MEDITERRANEAN AND WESTERN NUTRITION?
Authors: Dana Simu, Adrian Copcea, Ilinca Lenta, Tudor Simu

Introduction
: Romania finds itself, geographically and economically, halfway between the Balkans and Western Europe. High poverty rates, use of small scale agriculture co-exist with elements of the ‘western lifestyle’ on a population level. Objectives: We aimed to identify food intake patterns in Romania, in relation to individual and socioenvironmental characteristics. Methods: We applied a modified version of the NHANES food frequency questionnary to 300 adults matching the structure of the general population. We searched for correlations between nutrient frequencies, clinical and sociological characteristics. The results were interpreted in relation to generally recognized elements of Western or mediteranean nutrition. Results: Within the group (52% females, 53% urban population, aged 18 to 75), there were significant differences for dietary habits related to demographical characteristics, age and education level. Dairy products, red meat and alcohol intake were significantly more frequent in the rural population (71.4%, 64.3% respectively 59.6% for the 1st quartile for frequency), fast food consumption was positively correlated with education level, urban location and inversely correlated with age. Monounsaturated fat consumption was less than 5% from total fat. The most significant differences for food compound structure were found between young, urban participants (suggesting a Western, non-mediterranean pattern) and older participants from the countryside (suggesting a non-Western, non-mediterranean pattern). Conclusions. Food intake patterns in Romania are more closely resemblant to western patterns rather than to mediterranean ones, especially for young urban population. From a nutritional point of view, economic progress seems to bring no benefit, neither does keeping old traditions.

EVOLUTION OF ELDERLY PATIENTS DIAGNOSED WITH METABOLIC SYNDROME TO DIABETES MELLITUS AND ITS COMPLICATIONS
Authors: Luminita Pasca, Ramona Fagea, Adrian Copcea, Dana Simu, Valer Donca

Background. Type 2 diabetes [T2DM] is considered by some authors a severe form of metabolic syndrome [MS]. Diabetes complications may appear before diagnosis, especially in patients with MS. Objective. The aim of this study is to evaluate the clinic and metabolic status in a group of elderly patients with MS and T2DM, previously followed for Impaired Fasting Glucose [IFG]. Methods. 100 patients were selected by the following criteria: 1) age over 65; 2) newly diagnosed T2DM; 3) previously diagnosed IFG (fasting blood glucose [FBG] ≥ 110 mg/dl), 4) MS (IDF 2005 criteria). The mean age in the group was 73, mean BMI 30.2 kg/m2, 46% of the patients were males, 64% urban population. The analysis included demographic characteristics, clinical features and laboratory measurements (FBG, HbA1c, lipid profiles), documented micro- and macrovascular complications of diabetes at onset. Results. Diabetes was diagnosed 2,5 years after the diagnosis of IFG. 72% of patients had at least a microvascular complication at diagnosis. Prevalence rates were: 60% for polyneuropathy, 34% retinopathy, 6% nephropathy.  Coronary heart disease was present in  48% of patients, cerebrovascular disease in 14 % and arteriopathy in 16 %. Complications were present in similar rates among sexes. We found no significant correlation between complications rates and FPG at diagnosis of IFG or DM. Conclusions. The prevalence of microvascular complications at the onset of diabetes, in this group of elderly patients with preexisting metabolic syndrome, was high (72%). Early treatment targeting FBG may be appropriate in elderly patients with metabolic syndrome.

HIPPOPHAEA RHAMNOIDES INTERFERES WITH INSULIN RELEASE VIA L-TYPE CA 2+ CHANNEL-MEDIATED PATHWAY IN RAT ISLET Β-CELLS
Authors: Stelian V. Şarlea, Adela E. Joanta, Adrian Copcea

Diabetes Mellitus (DM) continues to be a world public health problem, having a cascade of complications such as cardiovascular disease, chronic renal failure, retinal damage, nerve damage, and microvascular damage, which may cause erectile dysfunction (impotence) and poor healing of wounds. Recent studies showed that complications are generated by the Oxidative Stress induced by the hyperglycemia. Polyunsaturated fatty acids, such as oleic acid have an antioxidant effect, being found in high concentration in Hippophaea rhamnoides. Our aim is to explore the in vivo molecular mechanism of action of oleic acid by using a molecular modeling simulation software, Molegro Virtual Docker (MVD) and to observe the antioxidant effect of Hippophaea rhamnoides extract in different circumstances related to insulin release from rat islet β-cells.
Experiments were performed on white, male, Wistar rats, organized as follows: group 1: control-standard diet, group 2: rats fed a diet enriched in sea buckthorn: (Hippophaea rhamnoides), group 3: rats fed a diet enriched in sea buckthorn and glucose, group 4: rats treated with L-type Ca 2+ channel blocker (Nifedipine), fed a diet enriched in sea buckthorn and glucose, group 5: rats treated with Nifedipine, fed a diet enriched in glucose. Glycemia level, oxidative stress markers (lipid peroxides, carbonyl proteins) and antioxidant defense (superoxiddismutase, catalase) were assessed from blood, pancreas and myocardium after 1 and 2 weeks of experiment. It was noticed a significant increase in glycemia level in group 5 as compared to group 4. These data suggest through an indirect manner that Hippophaea rhamnoides stimulates Ca 2+ influx through L-type Ca 2+ channels in β-cells, followed by insulin release. Also, it was observed an increase in oxidative stress markers and a decrease in antioxidant defense of the analyzed tissues in animals from group 3 and 5. A possibility is that long-term exposure to fatty acids from Hippophaea rhamnoides, correlated to glucose administration could induce long-lasting elevation of Ca 2+, thereby evoking the Ca 2+ toxicity and consequent dysfunction of islet β-cells. By using the MVD software we’ve observed the in vivo binding mechanism of oleic acid and its antioxidant effects on oxidative damaged cells and also the best binding positions for the best antioxidant effect. Present data suggest that the fatty acids consisted in Hippophaea rhamnoides interferes with insulin release via L-type Ca 2+ channel-mediated pathway in rat islet β-cells. A new approach regarding therapeutical alternatives in diabetes mellitus has to be considered.

THE PREVALENCE OF THE METABOLIC SYNDROME IN A MALE POPULATION WITH ERECTILE DYSFUNCTION  
AuthorsVasile Coca, Mariana Cecilia Coca, Georgiana Nicolescu, Adrian Copcea, Nicolae Hancu

Objectives: To establish the prevalence and the correlations of metabolic syndrome (MetS) with erectile dysfunction (DE).
Materials and methods: initially evaluated for ED from 2000 to 2005, was retrospectively assessed. Metabolic syndrome was considered according to the IDF Consensus derived from The National Cholesterol Education Program/ Adult Treatment Panel III. For ED assessment, it was used the Sexual Health Inventory for Men (SHIM) questionnaire. The cardiovascular risk (CVR) was assessed by the Systematic Coronary Risk Evaluation (SCORE) diagram. Each element of MetS was correlated with the severity of ED and with the CVR.
A cohort of 1278 men with ages between 27 and 59 years (48,3±6,24),
Results: Prevalence of MetS was 30,14% (322 cases). ED was correlated with high waist circumference (j=0,884; p<0,001) with hypertension (j=0,601; p<0,08) and hypertriglyceridemia (j=0,392; p<0,05). Relative risk (RR) to induce ED was significant for central obesity: RR=0,85 (0,69-1,39), p<0,001 and for hypertension: RR= 0,72 (0,42-1,15) p<0,001. The severity degree of ED was directly correlated to the incidence of MetS clinical components. Prevalence of severe ED in MetS (39,62%) compare with that in the general population (22%) was significant (p<0,001). Prevalence of the high CVR (SCORE > 15%) in MetS + ED vs. other organic causes of ED was: 24,73% vs. 9,14% (p<0,001).
Organic ED was found in 1068 cases (83,57%), whereas psychological ED in 210 cases (16,42%).
Conclusions: 
MetS is a frequent cause of ED that increases its severity degree. In people with MetS, ED predicts a highest CVR.
FULL TEXT:
http://www.maedica.org/articole/Art_04.pdf

 



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