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Background/Aim. Prolonged hyperinsulinemia accelerates the process of endothelial dysfunction and arteriosclerotic changes affecting the development of cardiovascular and cerebrovascular diseases. There are various measuring techniques for the evaluation of early functional changes in the arterial wall such as: flow-mediated endothelium-dependent vasodilation, impulse wave analysis, intima-media thickness assessment, venous plethysmography and so on; however, each has certain limitations in results interpretation. The aim of this study was to indicate the association of the pulsatility index (PI) that shows peripheral arterial contractility, with the changes in metabolic parameters under insulin resistance conditions. Methods. The study included a total of 30 healthy obese subjects with the values of body mass index more than 30 kg/m2, randomized with double blind design into two groups: placebo and orlistat. The extent of insulin sensitivity was calculated on the basis of glycemia and insulinemia values using an appropriate formula. Results. The obtained results suggest a statistically significant improvement in the PI index in the orlistat group (p < 0.002), while there was no such improvement in the placebo group. Conclusion. The results obtained in this study indicate the improvement in insulin sensitivity within early arteriosclerosis is a significantly favorable effect of orlistat on peripheral arterial circulation additionally supported by the reduction in levels of lipid fractions, especially triglycerides. Early hemodynamic changes under conditions of the reduced insulin resistance are characterized by the increase in arterial wall contractility evaluated by the PI determination.

Background/Aim. Inflammation is the most important factor in the genesis of vascular complication in the endstage renal disease. The serum C-reactive protein (CRP) level is a sensitive marker of systemic inflammation as well as a predisposing factor for cardiovascular and all cause mortality in patients on hemodialysis. Albumin is the negative acute phase protein and its synthesis declines during the inflammation. The patients undergoing hemodialysis have a high prevalence of protein-energy malnutrition, due to reduced protein synthesis and increased degradation. The low serum albumin levels in these patients originate from the complex setting of conditions with systemic inflammatory response as a major cause, malnutrition and overhydratation. The aim of this study was to determine the prevalence of elevated CRP levels in the dialysis patients and to analyse its correlation with serum albumin levels and other parameters of nutritional status. Methods. The study included 49 patients on maintenance hemodialysis at the Department of Hemodialysis, Clinic of Nephrology, Military Medical Academy, Belgrade, Serbia. In order to analyse the parameters, the blood samples were taken during the arteriovenous fistula (AVF) puncture and before the second weekly dialyse. The following parameters were determined: serum levels of urea and creatinine before and after the dialysis procedure, CRP, hemoglobin, fasting glycemia, total cholesterol, triglycerides, albumins, iron, glycosylated hemoglobin (HbA1c), fasting insulinemia and C-peptide only before the dialysis. Results. Out of 49 patients on maintenance hemodialysis, 37 (75.5%) were males and 12 (24.5%) females with the average age of 56.04 ± 13.93 years. The average duration of the dialysis treatment was 7.37 ± 5 years. The high serum CRP levels (more than 3 mg/L) was found in 65.3% of patients. Singificantly more diabetic patients were observed in the group with the higher CRP levels (n = 12) compared to the group with the normal CRP levels (n = 3) (p ≤ 0.05). A significant positive correlation was found between the CRP value and urea values after the dialysis procedure. We found negative correlation between the CRP values and serum albumin, HbA1c, total cholesterol and triglyceride levels, with no statistical significance. Conclusion. Our study observed a high rate of inflammation in the dialysis patients presenting as high frequency of the elevated CRP levels in the examined group. Negative correlation between CRP levels and serum albumin as well as with some other parameters of nutritional status, suggests that chronic inflammation may be the missing link that actually connect protein energy malnutrition with high morbiditiy and mortality rate in these patients.

Background/Aim. Chronic obstructive pulmonary disease (COPD) has a significant impact on quality of life of patients. We investigated which demographic and social characteristics can predict the global quality of life (QoL) of COPD patients. Methods. The patients (n = 288) were divided into three groups according to the stage of disease: Group I = stage 0 – at risk; Group II = Stages I and II; Group III = stages III and IV. The patients fulfilled a questionnaire related to the demographic and social characteristics and the validated multidimensional questionnaire – Serbian version of the St. George’s Respiratory Questionnaire (SGRQ). The Student’s t test, χ² test, ANOVA, univariate and multivariate logistic regression tests were used for statistical analyses. Results. In the group I, prevailed the men, employed persons, with a moderate financial status and no family history of COPD. In the group II dominated women, pensioners, with a moderate financial status, duration of illness up to five years, and no family history of COPD. In the group III prevailed women, unemployed persons, a moderate financial status, COPD duration up to 5 years and no family history of COPD. The predictors of the Symptoms score were grades of COPD and duration of the disease, and the predictors of Activity grades of COPD, sex, age and financial status. All variables were found to have a statistically significant relationship in the Impact score in the pre-analyses, were also significant in the univariate regression model. They were age, employement status, financial status and COPD duration. The same predictors that significantly contributed to the explanation of the Impact score, contributed to the explanation of the Total score on SGRQ. In the multivariate regression model, the predictors of the Activity score, Impacts score and Total score were the COPD grade and financial status; only the COPD grade contributed to the explanation of the Symptoms score. Conclusion. Financial status is the most important social factor, and the grade of COPD is the best disease-related predictor of QoL of COPD patients.

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Background/Aim. Overweight/obesity has become important health problem in developed countries. It may be related to a presence of low-grade inflammation in white adipose tissue. The aim of this study was to investigate the levels of inflammatory marker C-reactive protein (CRP) and its relation to anthropometric parameters in overweight and obese females. Methods. This study included 200 apparently healthy, overweight and obese women (18–45 years). Their standard and alternative anthropometric parameters [body mass index (BMI), percentage of fat (%F), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI)] were determined and correlated to serum CRP concentration. Results. Average CRP level was 5.56 ± 2.43 mg/L, and it significantly positively correlated to all investigated anthropometric parameters. There was significant difference between overweight and obese group in all investigated anthropometric parameters, as well as in CRP values. When investigated separately, according to BMI, values regarding obese females showed significant correlation between CRP and every investigated anthropometric parameter. In overweight subjects, no such correlation was recorded. In the obese group, all investigated parameters were significantly related to F. In overweight subjects, body weight (BW), BMI, WC and WHtR showed significant relation to F. Conclusion. The significant difference between the overweight and obese group in all parameters of central obesity was found as well as in the CRP levels. In the obese group, we found strong correlation between adiposity measured by fat percentage and parameters of central obesity, while in the overweight group WHR and BAI did not correlate to fat percentage. Our results confirmed that CRP is a valuable marker of metabolic risk in obese females, and BMI, although not so new, is still reliable parameter of adiposity.

Background/Aim. Chronic renal disease is one of the growing problems all over the world. Health-related quality of life (HRQoL) is an important indicator for those with a chronic disease, such as chronic renal disease, because it may serve as predictor of mortality and hospitalization. The aim of this study was to assess HRQoL in patients on chronic maintenance hemodialysis (HD), and compare it with patients suffering from hypertension (HTA), and normal controls of the same age and gender (C). Methods. The study enrolled 224 males and females older than 18 years: 67 in the HD group, 78 in the HTA group, and 79 in the C group. HRQoL was assessed in all groups using 15-D questionnaire. Results. Significantly higher level of education was recorded in the HD group compared to other two groups. In the HD group there were significantly less employed persons (9%) and significantly more retired (67.2%). All groups were similar regarding an average monthly income and marital status. We found significantly lower total HRQoL score in patients in the HD group, compared to normal controls (0.78 ± 0.16 vs. 0.89 ± 0.10 in the HTA and 0.95 ± 0.06 in the C group) as well as specific scores in almost all investigated domains, except in speech, eating and mental functions. Patients in the HD and HTA groups had similar self-reported quality of life in additional 3 domains: hearing, elimination and distress, while the HD group reported significantly lower scores in remaining 9 domains: mobility, vision, breathing, sleeping, usual activities, discomfort and symptoms, depression, vitality and sexual activity. Patients in the HTA group had significantly lower scores than normal controls in 8 domains (hearing, sleeping, elimination, usual activities, discomfort and symptoms, depression, distress and vitality) as well as in total quality of life, while in remaining 4 domains there was no significant difference (mobility, vision, breathing, sexual activity). Conclusion. Both investigated chronic diseases lead to impairment of HRQoL, which is substantially stronger in hemodialysis than in hypertension. Considering the relationship between depression and HRQoL measures, it may be useful to treat depression of HD patients in order to improve their quality of life.

Background/Aim. Obesity is an established risk factor for numerous chronic diseases. The aim of this study was to investigate the effect of well-balanced different caloric restriction (CR) diets on anthropometric parameters and standard biochemical cardiovascular risk markers [lipid profile, glucose homeostasis and high sensitivity C-reactive protein (hs-CRP)] in overweight/obese females. Methods. Participants (age 20– 40 years) were randomized into 3 different CR diet groups: the group I – restriction of 20% calories from baseline energy requirements, the group II – restriction of 50% calories from baseline energy requirements and the group III – alternating daily diets with 70%/30% restriction. The study lasted 42 weeks. Anthropometric parameters were measured at the start and after 4, 8, 20 and 42 weeks after dietary intervention beginning. Biochemical markers were determined at baseline and after 20 and 42 weeks from dietary restriction start. Results. Body weight, body mass index (BMI), waist circumference (WC) and body fat (in %), in the different CR diet groups significantly decreased after 42 weeks. Body weight was less 11 kg in the group I and 12 kg in the groups II and III. WC was reduced by 11 cm in the groups I and III and by 10 cm in the group II. Different CR diets had the same effects on body fat (a reduction of 15% of body fat). Total cholesterol decreased by 7% in the group I and by 8% in the group III. Low density lipoprotein (LDL) cholesterol decreased by 14% in the group I and by 13% in group III. There were no significant changes in total and LDLcholesterol levels in the group II. The atherogenic index presented as trigliceride/high density lipoprotein (TG/HDL) ratio decreased by 0.22 in the group I, by 0.25 in the group II and by 0.32 in the group III. Various CR diets had the same effects on reducing the hs-CRP levels. Conclusion. Different CR diets with the same macronutrient content are equally effective in reducing body weight, WC and body fat, improve cardiometabolic risk factors and decrease level of proinflammatory hs-CRP in overweight/obese females.

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Background/Aim. Motivated and job satisfied health professionals represent a basis of success of modern health institutions. The aim of this study was to investigate whether there was a difference in work motivation and job satisfaction between health workers in urban and rural areas in the region of Central Serbia. Methods. The study included 396 health professionals from urban setting, and 436 from a rural area, employed in four randomly selected health facilities. An anonymous questionnaire was used for data gathering. Statistical analysis was performed using χ2, Student t-test, Spearman's correlation coefficient, and logistic regression analysis. Results. Urban health professionals were significantly more motivated and job satisfied than respondents from rural area. In relation to work motivation factors and job satisfaction of health professionals in urban and rural areas, there were no significant differences in working conditions and current equipment, and in terms of job satisfaction there were no significant differences in relation to income either. Conclusion. In order to increase the level of work motivation and job satisfaction of health workers in rural areas, apart from better income, they should get more assistance and support from their supervisors, and awards for good job performance; interpersonal relationships, promotion and advancement opportunities, managerial performance and cooperation at work should be improved; employment security should be provided, as well as more independence at work, with professional supervision of health workers.

Background/Aim. Data on sodium intake and sources of sodium in the diet in Serbia are limited. The aim of this study was to estimate the sodium intake and identify the sources of sodium in the diet of undergraduate students attending the University of Novi Sad. Methods. Students completed a questionnaire to gather data on their gender, age and university faculty attended, and then a 24 h dietary recall. The sodium intake of the students was calculated using the dietary recall data and data on the sodium content of foods. The contribution of different food groups as well as of specific foodstuffs to the total sodium intake was calculated. Results. The mean estimated sodium intake of the students was 3,938.5 ± 1,708.1 mg/day. The sodium intake of 89.1% of the surveyed students exceeded the guideline for sodium intake, the majority of the sodium coming from processed foods (78.9% of the total sodium intake). The food groups that contributed the most to the total sodium intake of the students were meat and meat products (21.7%) and cereals and cereal-based products (18.6%). Bread and other bakery products were responsible for 13.1% of the total sodium intake. Conclusion. High sodium intake in students of the University of Novi Sad puts them at high risk of developing high blood pressure. The food industry should work towards reformulating products with high sodium content, especially bread and other bakery products. Efforts should be taken to reduce sodium intake among undergraduate students in Novi Sad.

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Background/Aim. Morbidity and mortality of continous ambulatory peritoneal dialysis (CAPD) patients is still very high. The aim of the study was to evaluate the effects of peritoneal dialysis (PD) solutions (standard vs biocompatible) on long-term patients’ and the techique survival. Methods. A total of 42 stable patients on CAPD participated in this crosssectional study. They were prospectively followed-up during the twelve years. Patients with severe anemia (Hb < 10 g/L) and malignant disease ware excluded. Twenty one (50%) patients were treated with the standard PD solutions (CAPDP- 1) while the other 21 (50%) were treated with biocompatible PD solutions [(lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH (CAPDP-2)]. All patients were analyzed for a presence of vascular calcification, nutrition status, and parameters of inflammation after 2.5 ± 0.6 years of starting CAPD, and these variables considered in the analysis as risk factors. Results. The patients from the group CAPDP-2 compared to those from the group CAPDP-1 had lower level of high-sensitivity C-reactive protein (hs-CRP) (p = 0.003), and better nutritional status as confirmed by the mid-arm circumference (p = 0.015), and midarm muscle circumference (p = 0.002) and subjective global assessment (p = 0.000). Also, they had lower vascular calcifications as confirmed by intima media thickness (IMT) (p = 0.003), degree of carotid narrowing (p = 0.001) and calcified plaques of common carotid arteries (CCA) (p = 0.008). Kaplan- Meier analysis confirmed better survival of patients from the group CAPDP-2 than those from the group CAPDP-1 (1-, 5-, and 10-year patients survival rate was: 100%, 61.9% and 14.3% for the group CAPDP-1, and 100%, 85.7%, and 52.4% for the group CAPDP-2, respectively; p = 0.0345). The 1-, 5-, and 10-year technique survival rate was: 100%, 71.4%, and 38.1% for the group CAPDP-1, and 100%, 85.7%, and 76.2% for the group CAPDP-2, respectively; (p = 0.0719). Duration of dialysis, serum triglyceride and cardiovascular score (quantitative scoring system consisting of: ejection fraction (EF) of left ventricle < 50%; IMT > 1 mm; carotid narrowing degree > 50%, presence of carotid plaques in both common carotide, ischaemic heart disease, cerebrovascular event and peripheral vascular disease with or without amputation) were independent predictors of overall patient survival. Duration of dialysis was only independent predictor of overall technique survival. Conclusion. Although patients treated with biocompatible solutions showed significantly better survival, the role of biocompatibility of CAPD solutions in patients and technique survival have to be confirmed. Namely, multivariate analysis confirmed that duration of dialysis, serum triglyceride and cardiovascular score significantly predicted overall CAPD patients survival, while only duration of dialysis was found to be independent predictor of overall techique survival.

Background/Aim. Iron is a vital constituent of hemoglobin, myoglobin, and some mitochondrial enzymes; therefore, body iron deficiency may result in reduced aerobic capacity. The aim of this study was to evaluate the effects of daily oral iron supplementation on body iron status, and the maximal oxygen uptake (VO2max) in female athletes with latent iron deficiency, as well as with irondeficiency anemia. Methods. A total of 37 female volleyball players were included in the study. Seventeen female athletes had latent iron deficiency, and 20 ones iron deficiency anemia. Both groups were divided into the experimental and the control group. The experimental groups received a daily oral iron supplement (200 mg ferrous sulfate), for a two-month training course. Iron status was determined by serum parameters as follows: red blood cells count, hemoglobin concentration, serum iron and ferritin levels, an unsaturated iron binding capacity, total iron binding capacity and transferrin saturation. VO2max was determined by an indirect test. Results. Statistical difference between the latent iron deficient group versus the iron deficient anemic group was found regarding VO2max (p < 0.001). There were correlations between hemoglobin concentration and VO2max in the latent iron deficient group, as well as in the iron deficient anaemic group (p < 0.05). After two months, there was a significant increase in VO2max in all groups (from 7.0% to 18.2%). Values of VO2max at the end of training period were significantly different (45.98 ± 1.76 vs 42.40 ± 1.22 mL/kg/min; p

Background/Aim. Inflammation plays a key role in the physiopathology of arteriosclerosis. C-reactive protein (CRP) and common carotid artery intima-media thickness are independent predictors of cardiovascular events and diabetes mellitus in apparently healthy men, but relationship between them is not fully elucidated. The aim of the study was to assess the cross-sectional relationship between CRP and cardiovascular risk factors with common carotid artery intima-media thickness in military pilots as representatives of healthy men. Methods. We studied 161 military pilots (age 38 ± 6 years) free of cardiovascular disease and diabetes mellitus. Traditional and metabolic risk factors were determined. Plasma CRP was measured by immunonephelometry. The common carotid artery intima-media thickness was measured by ultrasonography in the posterior wall of both common carotid arteries. Results. A total of 66.5% subjects had common carotid artery intima-media thickness > 0.9 mm (p < 0.01). The mean CRP plasma concentration was significantly higher in the subjects with common carotid artery intima- media thickness > 0.9 mm than in those with common carotid artery intima-media thickness ≤ 0.9 mm. In a simple regression analysis age adjusted CRP was associated with common carotid artery intima-media thickness (β = 0.285, p < 0.01), and only high density lipoprotein cholesterol was not associated with common carotid artery intima-media thickness. The association between CRP and common carotid artery intima-media thickness remained highly significant after controlling for body mass index, blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, glycosylated hemoglobin and smoking (p < 0.01). Controlling for glucose, triglycerides to high density lipoprotein cholesterol ratio, and total cholesterol to high density lipoprotein cholesterol ratio resulted in some reduction in the strength of the association, but including waist circumference in the regression made the relationship no longer significant (p = 0.119). Body mass index (β = 0.352; p < 0.01), total cholesterol to high density lipoprotein cholesterol ratio (β = 0.334; p < 0.01) and age (β = 0.190; p = 0.036) were the independent predictors of common carotid artery intima-media thickness. Conclusions. In the studied group of healthy men CRP per se is not an independent predictor of early arteriosclerosis, and may mediate the effect of certain traditional risk factors, especially visceral obesity, on promoting aterogenesis.

Background/Aim. Exertional heat stress is a common problem in military services. The aim of this study was to examine changes in body water and serum concentrations of some electrolites in soldiers during exertional heat stress (EHST), as well as effects of 10-day passive or active acclimation in a climatic chamber. Methods. Forty male soldiers with high aerobic capacity, performed EHST either in cool (20 ºC, 16 ºC WBGT-wet bulb globe temperature), or hot (40 ºC, 25 ºC WBGT) environment, unacclimatized, or after 10 days of passive or active acclimation. The subjects were allowed to drink tap water ad libitum during EHST. Mean skin (Tsk) and tympanic (Tty) temperatures and heart rates (HR) measured physiological strain, while sweat rate (SwR), and serum concentrations of sodium, potassium and osmolality measured changes in water and electrolyte status. Blood samples were collected before and immediately after the EHST. Results. Exertional heat stress in hot conditions induced physiological heat stress (increase in Tty, HR, and SwR), with significant decrease in serum sodium concentration (140.6±1.52 before vs 138.5±1.0 mmol/l after EHST, p < 0.01) and osmolality (280.7±3.8 vs 277.5±2.6 mOsm/kg, p < 0.05) in the unacclimatized group. The acclimated soldiers suffered no such effects of exertional heat stress, despite almost the same degree of heat strain, measured by Tty, HR and SwR. Conclusion. In the trained soldiers, 10-day passive or active acclimation in a climatic chamber can prevent disturbances in water and electrolytic balance, i.e. decrease in serum sodium concentrations and osmolality induced by exertional heat stress.

Background. It is well known that smoking is associated with an increase in arterial wall thickness. However, most studies of this problem have been undertaken in age and sex heterogeneous groups, as well as in patients with already present other conventional risk factors. The aim of this study was to assess the effect of cigarette smoking on arterial wall thickness of the common carotid artery in asymptomatic pilots. Methods. The imaging of intima−media thickness of the posterior wall of the distal 1 cm of both common carotid arteries was performed using a B mode ultrasound device, in 39 pilots (37.05 ± 6.66 years), for whom smoking was the single cardiovascular risk factor. Comparisons were made with 49 non-smokers (35.12 ± 7.39 years). Results. The posterior walls of both common carotid arteries were thicker in smokers (left, p < 0.05; right, p > 0,05). Intima-media thickness was significantly lower on the right side than on the left side in both smokers and nonsmokers (p < 0.01). Conclusion. Cigarette smoking as the single cardiovascular risk factor was associated with the wall thickness of the carotid arteries in our study. This finding indicated that early atherosclerosis was already present in pilots - smokers entering middle age.

Background/Aim. Insulin resistance is related to accelerated atherosclerosis, whereas weight loss is associated with the increasing insulin sensitivity, the improvement of functional and the morphological parameters of arterial circulation, and the reduction of cardiovascular morbidity and mortality. The aim of our study was to evaluate the influence of orlistat treatment on serum insulin level and functional and morphologic parameters of peripheral arterial circulation. Methods. We conducted a prospective, randomized, double − blind, placebo − controlled study. Thirty patients with body mass index over 30 kg/m2 normotensive, nonsmokers, without clinically manifested cardiovascular disease or diabetes were randomly assigned either orlistat (120 mg, 3 times daily; n = 20) or placebo (n = 10) in a double − blind manner. All of the patients were on individually calculated hypocaloric diet. The follow-up period was 24 weeks. Arterial pressure, fasting serum glucose and insulin level, triglycerides, total cholesterol and low density lipoprotein-cholesterol were determined at the beginning, following 3 and 6 months. Also, the intima − media thickness of right superficial femoral artery and the mean blood flow velocity were determined with ultrasonography. Results. Inside the period of 3 and 6 months, there were the greater reductions of body mass index, arterial pressure, fasting glucose and insulin level, total cholesterol, low density lipoproteins, as well as the greater reductions of mean velocity blood flow and peripheral pulse pressure in the orlistat group vs the placebo group (p < 0.01). Greater reductions in the waist circumference and intima − media thickness were registered following 6 months in the orlistat vs the placebo group (p < 0.01). Conclusion. In the group of obese patients orlistat therapy reduced risk factors, serum insulin level and improved early arterial functional changes as assessed with the reductions of the mean velocity blood flow and peripheral pulse pressure following 3 months. The regression of morphological changes, as assessed with the reduction in intima − media thickness, was feasible over the six − month period.

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