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hepatitis due to a relative elevation in AST but decreases in nonalcoholic steatohepatitis due to a relative increase in ALT. Hence, changes in ALT appear more sensitive in fatty hepatic inltration, the entity associated with the metabolic syndrome.85


whether ALT measurement should be considered in the diagnosis of the metabolic syndrome. The trend for a rise of RBC count with glucose concentrations needs further examination and explanation.


In contrast to glucose, correlating total cholesterol with the various parameters (Fig. 1a) improved the majority of them in a positive fashion. Correlations using HDL- cholesterol as the independent variable seems to demon- strate even a stronger improvement (Fig. 1b). When total cholesterol minus HDL was checked, most of the targeted parameters did not change signicantly (Fig. 1C). Only triglycerides concentrations correlated signicantly pos- itive strengthening the belief that the improvements shown in Fig. 1A were mostly due to the presence of HDL-cholesterol. The effects of LDL-cholesterol, not shown, simulated those of total cholesterol minus HDL- cholesterol and certainly do not show a worsening of the metabolic parameters (Fig. 1C).


Fig. 1. Examining various forms of cholesterol as independent variable. Fig 1A shows the r values for total cholesterol against the different parameters.


To ponder in the future is


Fig. 1B shows the r values for HDL-cholesterol against the different parameters.


Fig. 1C shows the r values for total cholesterol minus HDL-cholesterol. A star (*) under or above the       (p<0.05), while a hash mark (#) designates a trend (p<0.1>0.05). n= 192.


Fig. 2. Schema of hypothesis concerning the effects of glucose-insulin perturbations on the metabolic syndrome and aging.


In summing up, what lessons can be learned from these ndings? We conclude that circulating fasting glucose levels in the above data approximate the status of insulin sensitivity  in general, the higher the glucose readings, the less the sensitivity of tissues such as fat and muscle to insulin (insulin resistance). We believe further that these ndings reveal that the lower the levels of circulating fasting glucose short of hypoglycemia, the better off the general health status. What are ideal ranges? In our quartile study (Table 4), we found that dependent values measured were signicantly better when the glucose levels were in the range of 67-86 mg/dl than at 98-125 mg/dl. Additional examinations on all existing data must be carried out to come up with more exacting numbers for ideal ranges.


THE ORIGINAL INTERNIST JUNE 2016


(Continued on page 85) 83


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