Abril - 2017

ienov

328

ssoc

ras

2017; 63(4):324-331

sensory neuropathy.

Ziegler et al. found a 13% prevalence

of PPN in individuals with pre-diabetes, 11.7% in those

with impaired fasting blood glucose and 7.4% in normal

patients.

A study performed between 1999 and 2004 in

individuals aged over 40 years has shown that, compared

with patients without diabetes, pre-diabetic subjects had

11% higher risk of PPN.

Other groups have also revealed

higher than expected prevalence of pre-diabetes in patients

with idiopathic neuropathy in comparison with data of

the healthy population.

In our study, no difference was found between the

percentage of patients with positive criteria for pre-diabe-

tes (fasting hyperglycemia and altered hyperglycemia 2

hours after 75 g oral glucose intake in groups with and

without neuropathy), which suggests that the loss of gly-

cemic control is not the only mechanism determining PPN

in the group with neuropathy. In addition, there was no

association on univariate analysis between presence of PPN

and gender, age, weight, height, BMI, waist circumference,

SBP, DBP, MBP and serum levels of HDL-cholesterol, cre-

atinine, TSH and B12 vitamin.

After a multivariate Poisson regression using low

HDL-cholesterol and serum levels of LDL-cholesterol and

triglycerides, only low HDL-cholesterol was demonstrat-

ed to be independently associated with the presence of

PPN. Considering this study model, severely obese indi-

viduals with MetS and without DM with low HDL-cho-

lesterol had approximately four times higher prevalence

of PPN. This result is in accordance with the observation

by Callaghan et al. that triglyceride levels were positive-

ly related to the risk of amputation in patients with DM2

and that HDL-cholesterol levels between 40-59 mg/dL

confer protection against the probability of a lower limb

amputation.

Tesfaye et al. found cardiovascular risk factors as-

sociated with the development of neuropathy, such as

BMI and serum levels of total cholesterol, LDL-choles-

terol and triglycerides,

but in the KORA study,

serum

triglycerides were not associated with neuropathic pain.

In another research, there was an association of triglyc-

TABLE 2

Anthropometric and clinical data of 218 patients with MetS, degree II and III obesity, and without DM,

assessed for the presence of PPN. These figures represent the median. The values in parentheses correspond to 25% and

75% quartiles, respectively.

PPN Group (n=24)

No PPN Group (n=194)

p-value

Age (years)

34.5 (31.5; 43.8)

34 (29; 40.3)

0.350

Height (m)

1.66 (1.60; 1.68)

1.63 (1.58; 1.70)

0.866

Weight (kg)

118 (104; 139)

116 (104; 128)

0.443

BMI (kg/m²)

44.9 (39.4; 50.8)

42.5 (39.9; 46.3)

0.207

Waist circumference (cm)

123 (118; 136)

122 (116; 131)

0.374

SBP (mm/Hg)

130 (120; 140)

0.852

DBP (mm/Hg)

80 (72.5; 90)

80 (80; 90)

0.341

MBP (mm/Hg)

96.7 (93.3; 102)

96.7 (93.3; 103)

0.442

Fasting blood glucose (mg/dL)

89.4 (82; 99.8)

93.8 (86.8; 101)

0.273

Blood glucose 2h post-intake of 75 g of glucose (mg/dL)

126 (113; 147)

126 (106; 146)

0.889

HDL-c (mg/dL)

43.5 (37; 49)

45 (39; 50)

0.457

LDL-c (mg/dL)

128 (110; 144)

111 (89; 133)

0.046*

Triglycerides (mg/dL)

172 (97; 247)

132 (99; 192)

0.118

Creatinine (mg/dL)

0.82 (0.75; 0.90)

0.80 (0.70; 0.94)

0.965

TSH (mU/L)

2.5 (1.5; 4.5)

2.2 (1.6; 3.0)

0.437

B12 vitamin (pg/mL)

416 (343; 507)

449 (328; 655)

0.432

*Statistically significant (p<0.05).

Mann-Whitney U test.

BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; MBP: mean blood pressure; HDL-c: high-density lipoprotein cholesterol; LDL-c: low-density lipoprotein choles-

terol; MetS: metabolic syndrome; DM: diabetes mellitus; PPN: peripheral polineuropathy.

TABLE 3

Multivariate Poisson regression, in order to

evaluate which factors were independently associated to

the occurrence of PPN in the sample of degree II and III

obesity patients with MetS and without DM.

Variables

Model

PR (95CI)

p-value

Low HDL-c

4.12 (1.02 – 16.7)

0.047*

LDL-c

1.01 (1.00 – 1.02)

0.118

Triglycerides (mg/dL)

1.00 (0.99 – 1.01)

0.239

*Statistically significant (p<0.05).

HDL-c: high-density lipoprotein cholesterol; LDL-c: low-density lipoprotein cholesterol; MetS: me-

tabolic syndrome; DM: diabetes mellitus; PPN: peripheral polineuropathy; PR: prevalence ratio.