Monday, September 7, 2020

Metabolic Syndrome, Acidosis, and COVID-19 Comorbidities: Diabetes, Obesity and Old Age

 



What causes acidosis?

Acidosis is caused by an overproduction of acid that builds up in the blood or an excessive loss of bicarbonate from the blood (metabolic acidosis) or by a buildup of carbon dioxide in the blood that results from poor lung function or depressed breathing (respiratory acidosis).



Lactate levels greater than 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is generally defined as a serum lactate concentration above 4 mmol/L. Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients.Apr 6, 2020

https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916

 

Overview

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

Having just one of these conditions doesn't mean you have metabolic syndrome. But it does mean you have a greater risk of serious disease. And if you develop more of these conditions, your risk of complications, such as type 2 diabetes and heart disease, rises even higher.

Metabolic syndrome is increasingly common, and up to one-third of U.S. adults have it. If you have metabolic syndrome or any of its components, aggressive lifestyle changes can delay or even prevent the development of serious health problems.

Symptoms

Most of the disorders associated with metabolic syndrome don't have obvious signs or symptoms. One sign that is visible is a large waist circumference. And if your blood sugar is high, you might notice the signs and symptoms of diabetes — such as increased thirst and urination, fatigue, and blurred vision.

When to see a doctor

If you know you have at least one component of metabolic syndrome, ask your doctor whether you need testing for other components of the syndrome.

Causes

Metabolic syndrome is closely linked to overweight or obesity and inactivity.

It's also linked to a condition called insulin resistance. Normally, your digestive system breaks down the foods you eat into sugar. Insulin is a hormone made by your pancreas that helps sugar enter your cells to be used as fuel.

In people with insulin resistance, cells don't respond normally to insulin and glucose can't enter the cells as easily. As a result, your blood sugar levels rise even as your body churns out more and more insulin to try to lower your blood sugar.

Risk factors

The following factors increase your chances of having metabolic syndrome:

  • Age. Your risk of metabolic syndrome increases with age.
  • Ethnicity. In the United States, Hispanics— especially Hispanic women — appear to be at the greatest risk of developing metabolic syndrome.
  • Obesity. Carrying too much weight, especially in your abdomen, increases your risk of metabolic syndrome.
  • Diabetes. You're more likely to have metabolic syndrome if you had diabetes during pregnancy (gestational diabetes) or if you have a family history of type 2 diabetes.
  • Other diseases. Your risk of metabolic syndrome is higher if you've ever had nonalcoholic fatty liver disease, polycystic ovary syndrome or sleep apnea.

Complications

Having metabolic syndrome can increase your risk of developing:

  • Type 2 diabetes. If you don't make lifestyle changes to control your excess weight, you may develop insulin resistance, which can cause your blood sugar levels to rise. Eventually, insulin resistance can lead to type 2 diabetes.
  • Heart and blood vessel disease. High cholesterol and high blood pressure can contribute to the buildup of plaques in your arteries. These plaques can narrow and harden your arteries, which can lead to a heart attack or stroke.

Prevention

A lifelong commitment to a healthy lifestyle may prevent the conditions that cause metabolic syndrome. A healthy lifestyle includes:

  • Getting at least 30 minutes of physical activity most days
  • Eating plenty of vegetables, fruits, lean protein and whole grains
  • Limiting saturated fat and salt in your diet
  • Maintaining a healthy weight
  • Not smoking


. 2013 Dec 6; 8(12): 2034–2042.
Published online 2013 Sep 19. doi: 10.2215/CJN.03600413
PMCID: PMC3848400
PMID: 24052219

Dietary Acid, Age, and Serum Bicarbonate Levels among Adults in the United States


Summary

Background and objectives

Greater dietary acid has been associated with lower serum bicarbonate levels in patients with CKD. Whether this association extends to the general population and if it is modified by age are unknown.

Design, setting, participants, & measurements

This study examined the association of the dietary acid load, estimated by net endogenous acid production, with serum bicarbonate levels in adult participants in the National Health and Nutrition Examination Survey 1999–2004.

Results

The mean serum bicarbonate was 24.9 mEq/L (SEM=0.1), and the mean estimated net endogenous acid production was 57.4 mEq/d (SEM=0.4). Serum bicarbonate was linearly associated with age, such that the oldest participants had the highest serum bicarbonate levels. After multivariable adjustment, participants in the highest quartile of net endogenous acid production had 0.40 mEq/L (95% confidence interval, −0.55 to −0.26) lower serum bicarbonate and a 33% (95% confidence interval, 3 to 72) higher likelihood of acidosis compared with those participants in the lowest quartile. There was a significant interaction by age of the association of net endogenous acid production with serum bicarbonate (P=0.005). Among participants 20–39, 40–59, and ≥60 years old, those participants in the highest net endogenous acid production quartile had 0.26 (95% confidence interval, −0.49 to −0.03), 0.60 (95% confidence interval, −0.92 to −0.29), and 0.49 (95% confidence interval, −0.84 to −0.14) mEq/L lower serum bicarbonate, respectively, compared with participants in the lowest quartile.

Conclusion

Greater dietary acid is associated with lower serum bicarbonate in the general US population, and the magnitude of this association is greater among middle-aged and elderly persons than younger adults.



















 


Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies


Auxiliary markers that predict severe COVID-19 are as follows: (1) progressive decline in peripheral blood lymphocyte count; (2) progressive elevation in peripheral blood inflammatory factors such as IL-6 and the C-reactive protein; (3) progressive elevation in lactic acid level; (4) and imaging results showing bilateral or multilobar infiltration, pleural effusion, or short-term increase in lesions (32, 33). Interestingly, some researchers found that the neutrophil-to-lymphocyte ratio (NLR) is an influencing factor that can be used for early identification of the prognosis of patients with severe COVID-19. Patients aged ≥50 years and with NLR ≥3.13 tend to develop severe COVID-19 and should be admitted to the ICU immediately (34). Lastly, it should be pointed out that chest CT plays an extremely crucial role in COVID-19 diagnosis and the disease severity assessment. Chest CT has high diagnostic value in patients who have negative Reverse Transcription-Polymerase Chain Reaction (RT-PCR) results but whose clinical symptoms, auxiliary test results, and epidemiological history make them highly suspected patients (35).





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