Chronic idiopathic axonal polyneuropathy is associated with the metabolic syndrome

Nora A Visser, Alexander F J E Vrancken, Yvonne T van der Schouw, Leonard H van den Berg, Nicolette C Notermans, Nora A Visser, Alexander F J E Vrancken, Yvonne T van der Schouw, Leonard H van den Berg, Nicolette C Notermans

Abstract

Objective: This study aims to investigate the association between chronic idiopathic axonal polyneuropathy (CIAP) and the metabolic syndrome or its individual components.

Research design and methods: A total of 249 patients with CIAP and 709 controls underwent fasting laboratory studies, and blood pressure and waist circumference were measured. The metabolic syndrome was diagnosed if three or more of the following Adult Treatment Panel III criteria were present: impaired fasting glucose, hypertension, abdominal obesity, reduced HDL cholesterol, and hypertriglyceridemia. Subgroup analysis was performed for patients with a painful predominantly sensory CIAP, because this phenotype is most similar to diabetic polyneuropathy. Statistical analysis was performed with adjustment for age and gender.

Results: Fifty-five percent of all patients fulfilled the metabolic syndrome criteria compared with 34% of controls (odds ratio 2.2 [95% CI 1.7-3.0]). Multivariate analysis shows hypertension (2.9 [1.7-4.9]) and abdominal obesity (3.3 [2.4-4.6]) to be significantly more prevalent in patients than in controls. Of the patients classified as having a painful predominantly sensory CIAP, 62% fulfilled the metabolic syndrome criteria (3.1 [2.0-4.8]). In this subgroup, hypertension and abdominal obesity also were significantly more prevalent compared with controls.

Conclusions: Abdominal obesity and hypertension seem to be the most consistent contributing components of the metabolic syndrome in patients with CIAP. Evaluation and appropriate treatment of these risk factors in patients with CIAP would be advocated.

References

    1. Mygland A, Monstad P. Chronic polyneuropathies in Vest-Agder, Norway. Eur J Neurol 2001;8:157–165
    1. Rudolph T, Farbu E. Hospital-referred polyneuropathies—causes, prevalences, clinical- and neurophysiological findings. Eur J Neurol 2007;14:603–608
    1. Jann S, Beretta S, Bramerio M, Defanti CA. Prospective follow-up study of chronic polyneuropathy of undetermined cause. Muscle Nerve 2001;24:1197–1201
    1. Notermans NC, Wokke JH, Franssen H, et al. Chronic idiopathic polyneuropathy presenting in middle or old age: a clinical and electrophysiological study of 75 patients. J Neurol Neurosurg Psychiatry 1993;56:1066–1071
    1. Rosenberg NR, Vermeulen M. Should coeliac disease be considered in the work up of patients with chronic peripheral neuropathy? J Neurol Neurosurg Psychiatry 2005;76:1415–1419
    1. Vrancken AF, Franssen H, Wokke JH, Teunissen LL, Notermans NC. Chronic idiopathic axonal polyneuropathy and successful aging of the peripheral nervous system in elderly people. Arch Neurol 2002;59:533–540
    1. Dyck PJ, Dyck PJ, Klein CJ, Weigand SD. Does impaired glucose metabolism cause polyneuropathy? Review of previous studies and design of a prospective controlled population-based study. Muscle Nerve 2007;36:536–541
    1. Dyck PJ, Clark VM, Overland CJ, et al. Impaired glycemia and diabetic polyneuropathy: the OC IG Survey. Diabetes Care 2012;35:584–591
    1. Rajabally YA. Neuropathy and impaired glucose tolerance: an updated review of the evidence. Acta Neurol Scand 2011;124:1–8
    1. Teunissen LL, Notermans NC, Jansen GH, Banga JD, Veldman H, Wokke JH. Thickness of endoneurial vessel basal lamina area in chronic idiopathic axonal polyneuropathy. Acta Neuropathol 2000;100:445–450
    1. Grundy SM, Cleeman JI, Daniels SR, et al. American Heart Association. National Heart, Lung, and Blood Institute Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735–2752
    1. Merkies IS, Lauria G. 131st ENMC international workshop: selection of outcome measures for peripheral neuropathy clinical trials 10-12 December 2004, Naarden, The Netherlands. Neuromuscul Disord 2006;16:149–156
    1. Erdmann PG, Teunissen LL, van Genderen FR, et al. Functioning of patients with chronic idiopathic axonal polyneuropathy (CIAP). J Neurol 2007;254:1204–1211
    1. Merkies IS, Schmitz PI, van der Meché FG, van Doorn PA, The Inflammatory Neuropathy Cause and Treatment (INCAT) Group Reliability and responsiveness of a graduated tuning fork in immune mediated polyneuropathies. J Neurol Neurosurg Psychiatry 2000;68:669–671
    1. Rajabally YA, Narasimhan M. Characteristics and correlates of sensory function in chronic inflammatory demyelinating polyneuropathy. J Neurol Sci 2010;297:11–14
    1. Franssen H, Notermans NC, Wieneke GH. The influence of temperature on nerve conduction in patients with chronic axonal polyneuropathy. Clin Neurophysiol 1999;110:933–940
    1. England JD, Gronseth GS, Franklin G, et al. American Academy of Neurology. American Association of Electrodiagnostic Medicine. American Academy of Physical Medicine and Rehabilitation Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005;64:199–207
    1. Vrancken AF, Kalmijn S, Brugman F, Rinkel GJ, Notermans NC. The meaning of distal sensory loss and absent ankle reflexes in relation to age: a meta-analysis. J Neurol 2006;253:578–589
    1. Vrancken AF, Notermans NC, Wokke JH, Franssen H. The realistic yield of lower leg SNAP amplitudes and SRAR in the routine evaluation of chronic axonal polyneuropathies. J Neurol 2008;255:1127–1135
    1. Rajabally YA, Nicolas G, Piéret F, Bouche P, Van den Bergh PY. Validity of diagnostic criteria for chronic inflammatory demyelinating polyneuropathy: a multicentre European study. J Neurol Neurosurg Psychiatry 2009;80:1364–1368
    1. Lebrun CE, van der Schouw YT, Bak AA, et al. Arterial stiffness in postmenopausal women: determinants of pulse wave velocity. J Hypertens 2002;20:2165–2172
    1. Muller M, Grobbee DE, den Tonkelaar I, Lamberts SW, van der Schouw YT. Endogenous sex hormones and metabolic syndrome in aging men. J Clin Endocrinol Metab 2005;90:2618–2623
    1. van den Donk M, Bobbink IW, Gorter KJ, Salomé PL, Rutten GE. Identifying people with metabolic syndrome in primary care by screening with a mailed tape measure: a survey of 14,000 people in the Netherlands. Prev Med 2009;48:345–350
    1. Dekker JM, Girman C, Rhodes T, et al. Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn Study. Circulation 2005;112:666–673
    1. Blokstra A, Vissink P, Venmans LMAJ, et al. Measuring the Netherlands. A monitoring study of risk factors in the general population, 2009-2010. The National Institute for Public Health and the Environment (RIVM) report 260152001/2011:1-27. Available at: Accessed July 9, 2012
    1. Teunissen LL, Franssen H, Wokke JH, et al. Is cardiovascular disease a risk factor in the development of axonal polyneuropathy? J Neurol Neurosurg Psychiatry 2002;72:590–595
    1. Zarrelli MM, Amoruso L, Beghi E, Apollo F, Di Viesti P, Simone P, Italian General Practitioner Study Group Arterial hypertension as a risk factor for chronic symmetric polyneuropathy. J Epidemiol Biostat 2001;6:409–413
    1. Cho DY, Mold JW, Roberts M. Further investigation of the negative association between hypertension and peripheral neuropathy in the elderly: an Oklahoma Physicians Resource/Research Network (OKPRN) Study. J Am Board Fam Med 2006;19:240–250
    1. Lee CM, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 2008;61:646–653
    1. Hughes RA, Umapathi T, Gray IA, et al. A controlled investigation of the cause of chronic idiopathic axonal polyneuropathy. Brain 2004;127:1723–1730
    1. Rajabally YA, Shah RS. Dyslipidaemia in chronic acquired distal axonal polyneuropathy. J Neurol 2011;258:1431–1436
    1. Hoffman-Snyder C, Smith BE, Ross MA, Hernandez J, Bosch EP. Value of the oral glucose tolerance test in the evaluation of chronic idiopathic axonal polyneuropathy. Arch Neurol 2006;63:1075–1079
    1. Novella SP, Inzucchi SE, Goldstein JM. The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy. Muscle Nerve 2001;24:1229–1231
    1. Smith AG, Rose K, Singleton JR. Idiopathic neuropathy patients are at high risk for metabolic syndrome. J Neurol Sci 2008;273:25–28
    1. Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M. The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology 2003;60:108–111
    1. Balion CM, Raina PS, Gerstein HC, et al. Reproducibility of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) classification: a systematic review. Clin Chem Lab Med 2007;45:1180–1185
    1. Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol 2012;11:521–534
    1. Dharmashankar K, Widlansky ME. Vascular endothelial function and hypertension: insights and directions. Curr Hypertens Rep 2010;12:448–455
    1. Jonk AM, Houben AJ, de Jongh RT, Serné EH, Schaper NC, Stehouwer CD. Microvascular dysfunction in obesity: a potential mechanism in the pathogenesis of obesity-associated insulin resistance and hypertension. Physiology (Bethesda) 2007;22:252–260

Source: PubMed

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