THE RELATIONSHIP BETWEEN LEPTIN AND ANTHROPOMETRIC PARAMETERS IN TYPE 2 DIABETIC PATIENTS IN KANO, NIGERIA


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TABLE OF CONTENT

Title Page
Abstract
Table of contents
Abbreviations

CHAPTER ONE
1.0       INTRODUCTION
1.1       Statement of research problem
1.2       Rationale/ justification
1.3       Missing link
1.4       Aim and objectives
1.4.1 Aim
1.4.2 Objectives
1.5       Research hypothesis

CHAPTER TWO
2.0       LITERATURE REVIEW
2.1       Blood glucose homeostasis
2.1.1    Blood glucose regulation
2.1.2 Insulin hormone and blood glucose homeostasis
2.1.3 Mechanism of action of insulin
2.1.4 Role of insulin in metabolism
2.1.5 Insulin resistance
2.1.6 Role of catabolic hormone in blood glucose homeostasis
2.1.6.1 Glucagon
2.1.6.2 Cortisol
2.1.6.3 Epinephrine
2.2       Adipocyte hormone leptin
2.2.1    Mechanism of action of leptin
2.2.2    Role of Leptin in blood glucose homeostasis
2.3       Obesity and type 2 diabetes mellitus
2.3.1    Pathophysiology of obesity
2.3.2    Role of adipose tissue in obesity
2.4       Pathogenesis of type 2 diabetes mellitus
2.5       Relationship between leptin, insulin and obesity in type 2 diabetes mellitus

CHAPTER THREE
3.0       MATERIALS AND METHOD
3.1       Materials
3.1.1 Instrument for data collection
3.2   Method
3.2.1 Study area
3.2.2    Study population
3.2.3 Study design
3.2.4 Sample size estimation
3.2.5    Sampling method
3.2.6  Inclusion and exclusion criteria
3.2.7    Procedure for data collection
3.2.8    Ethical considerations
3.2.9  Measurement of vital signs
3.2.10  Anthropometric measurements
3.2.11  Laboratory procedures
3.2.12  Data analysis
3.2.13  Limitation

CHAPTER FOUR
4.0       RESULTS
4.1       Socio-demographic characteristics of the respondents
4.1.1    Age and sex distribution
4.1.2    Educational status
4.1.3   Respondents‘ occupations
4.1.4    Respondents‘ ethnicity
4.1.5    Smoking and alcohol status of the respondents
4.1.6    Physical exercise of the respondents
4.2       Physiologic and biochemical parameter of respondents
4.2.1    Weight, height, body mass index, waist circumference, hip circumference and waist hip ratio of the respondents
4.2.2    Mean values of pulse rate, systolic, diastolic and mean arterial pressure of the respondents
4.3       Mean serum leptin, insulin and glucose levels of the respondents
4.3.1   Serum leptin levels of the respondent
4.3.2    Serum insulin levels of the respondents
4.3.3    Serum lipid levels of the respondents
4.4       Relationship between serum leptin, insulin, lipids, blood glucose and anthropometric parameters of the respondents
4.5       Relationship between leptin, obesity and type 2 diabetes mellitus

CHAPTER FIVE
5.0       Discussions
5.1       Weight, height, body mass index, waist circumference, hip circumference and waist hip ratio of the respondents
5.2   Serum leptin, insulin and glucose levels of respondents
5.2.1   Serum leptin levels of respondents
5.2.2    Serum insulin levels of respondents
5.2.3    Serum lipids levels of respondents
5.3       Relationship between leptin, insulin, fasting blood glucose and anthropometric parameters of respondents

CHAPTER SIX
6.0       SUMMARY, CONCLUSION AND RECOMMENDATIONS
6.1       Summary
6.2       Conclusion
6.3       Recommendations
REFERENCES
APPENDICES



ABSTRACT


Obesity, a state of hyperleptinemia and leptin resistance, may play a role in the aeitiopathogenesis of type 2 diabetes mellitus. Leptin hormone which was originally recognized for its role as a satiety factor has now been implicated in a wide variety of multisystem biological functions, including the regulation of glucose homeostasis. However, there is paucity of information regarding leptin and its effect on the West African population. This study was therefore aimed at studying the relationship between leptin, obesity and insulin levels in type 2 diabetes mellitus. One hundred and eighty- three diabetics (183) and 96 control non-diabetics were studied. Pulse, blood pressure and anthropometric parameters of all the respondents were measured. Fasting blood sugar (FBS) was analyzed using the glucose oxidase method and lipid profile was determined using enzymatic method. Serum leptin and serum insulin were also analysed using enzyme linked immunoassay (ELISA) method. Homeostasis Model Assessment was used to determine insulin resistance. Type 2 diabetes mellitus patients and non- diabetic controls that were normotensive with no disease complications or associated chronic illness were used for the study. The mean serum leptin levels for the diabetics and non diabetics was observed to be 4.57 ± 0.17 ng/ml and 4.70 ± 0.25ng/ml respectively (p > 0.05) and the mean insulin level for the diabetic and non diabetic groups are 4.70 ± 0.25 μU/mL and 4.49 ± 0.01

μU/mL respectively (p < 0.05). A positive correlation was observed between leptin and body mass index (BMI) in both type 2 diabetic patients (r = 0.36, p < 0.05) and non-diabetics (r = 0.48, p < 0.05). A positive correlation was also found between leptin and waist circumference (WC) in both type 2 diabetic patients (r = 0.32, p < 0.05) and non-diabetics (r = 0.39, p < 0.05). Hip circumference (HC) also correlated positively with leptin in both the diabetics (r = 0.33, p < 0.05) and non-diabetics. The study also found a positive correlation between leptin and FBS in the non-diabetic group (r = 0.21, p < 0.05) but a negative correlation in the diabetic group(r = - 0.18, p < 0.05). A correlation was also found between leptin and HOMA-IR in both the diabetic (r = - 0.018, p < 0.05) and non-diabetics (r = 0.20, p < 0.05). However there was no significant relationship between leptin and insulin in both type 2 diabetic patients (r = 0.11, p > 0.05) and non-diabetics (r = - 0.06, p < 0.05). Age, BMI and WC emerged as the independent predictors of leptin in the diabetic group while BMI, WC and HC emerged as independent predictors of leptin in the non-diabetics.





CHAPTER ONE


INTRODUCTION


Leptin is a 167-amino-acid protein transcribed from the obese (ob) gene of mice and human subjects (Zhang et al., 1997; Brennan et al., 2006). The hormone is expressed and secreted from the adipose tissue of mice and humans, and the quantity secreted is highly correlated with body fat mass and adipocyte size (Maffei et al., 1995; Considine et al., 1996). Obese people have been shown to have higher leptin levels than normal weight in people (Maffei, 1995).


Leptin hormone was initially thought to play a vital role only in the regulation of food intake, energy expenditure, and whole-body energy balance in rodents and humans (Janechova et al., 2001). Since the discovery that leptin replacement improves insulin sensitivity and diabetes in mice homozygous for mutations of the obesity gene (ob gene), it is now been implicated in the pathophysiology of obesity and is shown to play a significant role in insulin resistance related to obesity (Harris et al., 1996). Leptin is also shown to play a role in blood glucose homeostasis (Heather et al., 2012). It has also been reported to normalize blood glucose and insulin levels in ob/ob mice with type 2 diabetes mellitus (Pellymounter, et al., 1995). Leptin has roles in insulin secretion by the β cells of the pancreas, and in the regulation of insulin action and energy metabolism in adipose tissue and skeletal muscle (Houseknecht et al., 1998). Reports from several studies also.....


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