A small proportion of lean patients develop non-alcoholic fatty liver disease (NAFLD). We aimed to report the histological picture of lean NAFLD in comparison to overweight and obese NAFLD patients. ...Biopsy and clinical data from 466 patients diagnosed with NAFLD were stratified to groups according to body mass index (BMI): lean (BMI ≤ 25.0 kg/m²,
confirmed to be appropriate = 74), overweight (BMI > 25.0 ≤ 30.0 kg/m²,
= 242) and obese (BMI > 30.0 kg/m²,
= 150). Lean NAFLD patients had a higher rate of lobular inflammation compared to overweight patients (12/74; 16.2% vs. 19/242; 7.9%;
= 0.011) but were similar to obese patients (25/150; 16.7%). Ballooning was observed in fewer overweight patients (38/242; 15.7%) compared to lean (19/74; 25.7%;
= 0.014) and obese patients (38/150; 25.3%;
= 0.006). Overweight patients had a lower rate of portal and periportal fibrosis (32/242; 13.2%) than lean (19/74; 25.7%;
= 0.019) and obese patients (37/150; 24.7%;
= 0.016). The rate of cirrhosis was higher in lean patients (6/74; 8.1%) compared to overweight (4/242; 1.7%;
= 0.010) and obese patients (3/150; 2.0%
= 0.027). In total, 60/466; 12.9% patients were diagnosed with non-alcoholic steatohepatitis (NASH). The rate of NASH was higher in lean (14/74; 18.9%
= 0.01) and obese (26/150; 17.3%;
= 0.007) compared to overweight patients (20/242; 8.3%)). Among lean patients, fasting glucose, INR and use of thyroid hormone replacement therapy were independent predictors of NASH in a multivariate model. Lean NAFLD patients were characterized by a severe histological picture similar to obese patients but are more progressed compared to overweight patients. Fasting glucose, international normalized ratio (INR) and the use of thyroid hormone replacement may serve as indicators for NASH in lean patients.
Background: This study assessed the predictive performance of inflammatory, hepatic, coagulation, and cardiac biomarkers in patients with prediabetes and diabetes mellitus hospitalized for COVID-19 ...in Austria. Methods: This was an analysis of a multicenter cohort study of 747 patients with diabetes mellitus or prediabetes hospitalized for COVID-19 in 11 hospitals in Austria. The primary outcome of this study was in-hospital mortality. The predictor variables included demographic characteristics, clinical parameters, comorbidities, use of medication, disease severity, and laboratory measurements of biomarkers. The association between biomarkers and in-hospital mortality was assessed using simple and multiple logistic regression analyses. The predictive performance of biomarkers was assessed using discrimination and calibration. Results: In our analysis, 70.8% had type 2 diabetes mellitus, 5.8% had type 1 diabetes mellitus, 14.9% had prediabetes, and 8.6% had other types of diabetes mellitus. The mean age was 70.3 ± 13.3 years, and 69.3% of patients were men. A total of 19.0% of patients died in the hospital. In multiple logistic regression analysis, LDH, CRP, IL-6, PCT, AST-ALT ratio, NT-proBNP, and Troponin T were significantly associated with in-hospital mortality. The discrimination of NT-proBNP was 74%, and that of Troponin T was 81%. The calibration of NT-proBNP was adequate (p = 0.302), while it was inadequate for Troponin T (p = 0.010). Conclusion: Troponin T showed excellent predictive performance, while NT-proBNP showed good predictive performance for assessing in-hospital mortality in patients with diabetes mellitus hospitalized with COVID-19. Therefore, these cardiac biomarkers may be used for prognostication of COVID-19 patients.
It is a matter of debate whether diabetes alone or its associated comorbidities are responsible for severe COVID-19 outcomes. This study assessed the impact of diabetes on intensive care unit (ICU) ...admission and in-hospital mortality in hospitalized COVID-19 patients.
A retrospective analysis was performed on a countrywide cohort of 40,632 COVID-19 patients hospitalized between March 2020 and March 2021. Data were provided by the Austrian data platform. The association of diabetes with outcomes was assessed using unmatched and propensity-score matched (PSM) logistic regression.
12.2% of patients had diabetes, 14.5% were admitted to the ICU, and 16.2% died in the hospital. Unmatched logistic regression analysis showed a significant association of diabetes (odds ratio OR: 1.24, 95% confidence interval CI: 1.15-1.34,
< 0.001) with in-hospital mortality, whereas PSM analysis showed no significant association of diabetes with in-hospital mortality (OR: 1.08, 95%CI: 0.97-1.19,
= 0.146). Diabetes was associated with higher odds of ICU admissions in both unmatched (OR: 1.36, 95%CI: 1.25-1.47,
< 0.001) and PSM analysis (OR: 1.15, 95%CI: 1.04-1.28,
= 0.009).
People with diabetes were more likely to be admitted to ICU compared to those without diabetes. However, advanced age and comorbidities rather than diabetes itself were associated with increased in-hospital mortality in COVID-19 patients.
Hyperferritinemia (HF) is a common finding and can be considered as metabolic HF (MHF) in combination with metabolic diseases. The definition of MHF was heterogenous until a consensus statement was ...published recently. Our aim was to apply the definition of MHF to provide data on the prevalence and characteristics of MHF in a Central-European cohort.
This study was a retrospective analysis of the Paracelsus 10,000 study, a population-based cohort study from the region of Salzburg, Austria. We included 8408 participants, aged 40-77. Participants with HF were divided into three categories according to their level of HF and evaluated for metabolic co-morbidities defined by the proposed criteria for MHF.
HF was present in 13% (n = 1111) with a clear male preponderance (n = 771, 69% of HF). Within the HF group, 81% (n = 901) of subjects fulfilled the metabolic criteria and were defined as MHF, of which 75% (n = 674) were characterized by a major criterion. In the remaining HF cohort, 52% (n = 227 of 437) of subjects were classified as MHF after application of the minor criteria.
HF is a common finding in the general middle-aged population and the majority of cases are classified as MHF. The new classification provides useful criteria for defining MHF.
Abstract Objective Elevated serum ferritin has been linked to type 2 diabetes (T2D) and adverse health outcomes in subjects with the Metabolic Syndrome (MetS). As the mechanisms underlying the ...negative impact of excess iron have so far remained elusive, we aimed to identify potential links between iron homeostasis and metabolic pathways. Methods In a cross-sectional study, data were obtained from 163 patients, allocated to one of three groups: (1) lean, healthy controls (n = 53), (2) MetS without hyperferritinemia (n = 54) and (3) MetS with hyperferritinemia (n = 56). An additional phlebotomy study included 29 patients with biopsy-proven iron overload before and after iron removal. A detailed clinical and biochemical characterization was obtained and metabolomic profiling was performed via a targeted metabolomics approach. Results Subjects with MetS and elevated ferritin had higher fasting glucose (p < 0.001), HbA1c (p = 0.035) and 1 h glucose in oral glucose tolerance test (p = 0.002) compared to MetS subjects without iron overload, whereas other clinical and biochemical features of the MetS were not different. The metabolomic study revealed significant differences between MetS with high and low ferritin in the serum concentrations of sarcosine, citrulline and particularly long-chain phosphatidylcholines. Methionine, glutamate, and long-chain phosphatidylcholines were significantly different before and after phlebotomy (p < 0.05 for all metabolites). Conclusions Our data suggest that high serum ferritin concentrations are linked to impaired glucose homeostasis in subjects with the MetS. Iron excess is associated to distinct changes in the serum concentrations of phosphatidylcholine subsets. A pathway involving sarcosine and citrulline also may be involved in iron-induced impairment of glucose metabolism.
Blutzuckerselbstkontrolle Update 2023 Wascher, Thomas C.; Stechemesser, Lars; Harreiter, Jürgen
Wiener Klinische Wochenschrift,
2023/1, Letnik:
135, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Zusammenfassung
Blutzuckerselbstkontrolle trägt zum integrierten Management des Diabetes mellitus bei. Sie sollte für alle Patienten mit Diabetes mellitus zur Verfügung stehen. Die ...Blutzuckerselbstkontrolle erhöht die Patientensicherheit, die Lebensqualität und verbessert die Blutzuckerkontrolle. Der vorliegende Artikel stellt die Behandlungsvorschläge der österreichischen Diabetesgesellschaft zum Einsatz der Blutzuckerselbstkontrolle dar.
Blutzuckerselbstkontrolle Update 2023 Wascher, Thomas C.; Stechemesser, Lars; Harreiter, Jürgen
Wiener Klinische Wochenschrift,
01/2023, Letnik:
135, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Blutzuckerselbstkontrolle trägt zum integrierten Management des Diabetes mellitus bei. Sie sollte für alle Patienten mit Diabetes mellitus zur Verfügung stehen. Die Blutzuckerselbstkontrolle erhöht ...die Patientensicherheit, die Lebensqualität und verbessert die Blutzuckerkontrolle. Der vorliegende Artikel stellt die Behandlungsvorschläge der österreichischen Diabetesgesellschaft zum Einsatz der Blutzuckerselbstkontrolle dar.
Blood glucose self monitoring Wascher, Thomas C; Stechemesser, Lars; Harreiter, Jürgen
Wiener Klinische Wochenschrift
135, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Self monitoring of blood glucose contributes to the integrated management of diabetes mellitus. It, thus, should be available for all patients with diabetes mellitus. Self monitoring of blood glucose ...improves patients safety, quality of life and glucose control. The current article represents the recommendations of the Austrian Diabetes Association for the use of blood glucose self monitoring according to current scientific evidence.
Postoperatives Management Parzer, Verena; Resl, Michael; Stechemesser, Lars ...
Wiener Klinische Wochenschrift,
11/2023, Letnik:
135, Številka:
Suppl 6
Journal Article
Recenzirano
Odprti dostop
Zusammenfassung
Die bariatrische Chirurgie führt zu einem signifikanten Gewichtsverlust, einer Reduktion oder gar Remission einer Vielzahl an Adipositas-assoziierten Begleiterkrankungen, einer ...Reduktion der Mortalität und einer Verbesserung der Lebensqualität vieler PatientInnen. Dennoch ist Adipositas eine chronische Erkrankung, die auch nach bariatrischer Operation eine Weiterbetreuung erforderlich macht. Zudem können kurz- oder langfristig spezifische Probleme auftreten, wie beispielsweise Mangelzustände verschiedener Mikronährstoffe und damit assoziierte Komplikationen. Bauchschmerzen sind ein immer ernst zu nehmendes Symptom nach bariatrischen Operationen. Ein weiteres Augenmerk sollte auf der Diagnose und Behandlung des Dumping-Syndroms liegen. Personen mit Typ-2-Diabetes sollen auch bei substanziell verbesserter bzw. normalisierter Glykämie regelmäßig auf wiederkehrende Hyperglykämie und spezifische Folgeerkrankungen gescreent werden. Neben spezialisierten Zentren mit multidisziplinären Teams wird der Primärversorgung und hier insbesondere ÄrztInnen für Allgemeinmedizin eine zunehmend wichtige Rolle in der Nachsorge nach bariatrischen Operationen zukommen.
Postoperative management Parzer, Verena; Resl, Michael; Stechemesser, Lars ...
Wiener Klinische Wochenschrift,
11/2023, Letnik:
135
Journal Article
Recenzirano
Odprti dostop
Bariatric surgery results in significant weight loss, reduction or even remission of obesity-associated comorbidities, reduced mortality, and improved quality of life in many patients; however, ...obesity is a chronic disease, thus follow-up care is required after bariatric surgery. Furthermore, specific issues, such as micronutrient deficiencies and subsequent complications, can arise both in the short-term and the long-term. Abdominal pain after bariatric surgery must always be regarded as a serious symptom. A further focus should be on the diagnosis and treatment of dumping syndrome. Patients with type 2 diabetes should be regularly screened for recurrent hyperglycemia as well as specific sequelae, even though blood glucose levels may be substantially improved or normalized. In addition to centers with multidisciplinary teams, primary care and, in particular, general practitioners will play an increasingly more important role in the follow-up care after bariatric surgery.
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