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Dominguez LJ, Sayón-Orea C, Gea A, Toledo-Atucha E, Bes-Rastrollo M, Barbagallo M, Martínez-González MA. CUN-BAE adiposity index prediction of incident type 2 diabetes: the Seguimiento Universidad de Navarra prospective cohort. J Nutr Health Aging 2025; 29:100545. [PMID: 40147296 DOI: 10.1016/j.jnha.2025.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 11/09/2024] [Accepted: 03/18/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND Obesity is currently a pandemic and a cardinal risk factor for incident diabetes, a parallel growing pandemic. Measures commonly used to define obesity, i.e., BMI and waist circumference, do not accurately reflect body fatness. METHODS We examined the prognostic value of body fatness assessed with the 'Clínica Universidad de Navarra-Body Adiposity Estimator' (CUN-BAE, range: 18.4-65.0 %) in 18,594 participants of the "Seguimiento Universidad de Navarra" prospective longitudinal cohort (60.5% women) without diabetes at baseline. Participants were followed-up with biennial questionnaires and multivariable-adjusted Cox models were used to estimate incident diabetes. RESULTS During 13.7 years of median follow-up, 209 participants developed diabetes. Progressively ascending quartiles of CUN-BAE were significantly associated with incident diabetes in multivariable-adjusted models, even after adjusting for BMI > 30 kg/m2. For each 2-unit increment in the CUN-BAE index, diabetes risk relatively increased by 46% in men and women (95% CI: 33%-62%). When comparing ROC AUC for CUN-BAE and BMI the association was stronger for CUN-BAE (p < 0.001). CONCLUSIONS CUN-BAE index, an easy equation that can be used in any clinical setting, predicted better the risk of incident diabetes compared to BMI. Our results emphasize the importance of reducing and maintaining a low adiposity in order to prevent diabetes.
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Affiliation(s)
- Ligia J Dominguez
- Department of Medicine and Surgery, University Kore of Enna, 94100 Enna, Italy; Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90127 Palermo, Italy.
| | - Carmen Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra-IdiSNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; Public Health Institute, 31003 Navarra, Spain.
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra-IdiSNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Estefania Toledo-Atucha
- Department of Preventive Medicine and Public Health, University of Navarra-IdiSNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra-IdiSNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90127 Palermo, Italy.
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra-IdiSNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, United States.
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Sehmbi T, Cao R, Sapkota R, Pardhan S. Knowledge and awareness of healthcare systems and the uptake of diabetic services among Chinese people diagnosed with type 2 diabetes in the UK. ETHNICITY & HEALTH 2025:1-18. [PMID: 40266023 DOI: 10.1080/13557858.2025.2496188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 04/16/2025] [Indexed: 04/24/2025]
Abstract
OBJECTIVES Diabetes poses a significant public health challenge. The Chinese community has unique cultural characteristics that can influence their understanding of the diabetes healthcare system and engagement with services. This study aims to explore the knowledge and awareness of the diabetes healthcare system and the uptake of healthcare services in the UK Chinese population. DESIGN This study adopted a qualitative design. Three focus group discussions (FGDs) were conducted on Zoom with 22 Chinese participants with self-reported type 2 diabetes living in the UK. Participants ranged from 24 to 85 years (mean age = 66 years, SD = 17.1). A purposive sample was recruited through study adverts in Chinese community centres and snowball sampling. Data were analysed using Braun and Clarke's thematic analysis (TA). RESULTS This paper discusses 4 themes: Awareness and understanding of diabetes, healthcare access and utilisation, attitudes towards diabetes prevention programmes and Chinese medicine vs. Western medicine. Limited knowledge and awareness of diabetes was highlighted, with cultural factors impacting this. Factors which impacted healthcare access and utilisation were linguistic/ communication challenges, and trust and perception of the NHS. Participants were unaware of diabetes prevention programmes and highlighted that these were culturally inappropriate. Generational preferences were noted in the way participants wished to receive diabetes education. The western medical system was viewed as medication focused, therefore the older Chinese community trusted familiar natural methods of illness management. CONCLUSION These findings highlight the importance of ensuring diabetes education is culturally appropriate. Generational differences in education preference should be recognised by healthcare professionals to increase healthcare engagement. These findings demonstrate the important need to educate UK healthcare professionals with the unique sociocultural contexts for this ethnic group. This study uncovers gaps in awareness and service uptake, highlighting the need for co-development of interventions that promote health equity and improve diabetes management within this population.
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Affiliation(s)
- Tarnjit Sehmbi
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Cambridge, UK
| | - Ran Cao
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Cambridge, UK
| | - Raju Sapkota
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Cambridge, UK
| | - Shahina Pardhan
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Cambridge, UK
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Benedict C, St-Onge MP. From Gestational Diabetes to Type 2 Diabetes-Is Poor Sleep to Blame? JAMA Netw Open 2025; 8:e250149. [PMID: 40042848 PMCID: PMC12076516 DOI: 10.1001/jamanetworkopen.2025.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
Affiliation(s)
- Christian Benedict
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Marie-Pierre St-Onge
- Center of Excellence for Sleep and Circadian Research, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Wong HJ, Sim B, Teo YH, Teo YN, Chan MY, Yeo LLL, Eng PC, Tan BYQ, Sattar N, Dalakoti M, Sia CH. Efficacy of GLP-1 Receptor Agonists on Weight Loss, BMI, and Waist Circumference for Patients With Obesity or Overweight: A Systematic Review, Meta-analysis, and Meta-regression of 47 Randomized Controlled Trials. Diabetes Care 2025; 48:292-300. [PMID: 39841962 DOI: 10.2337/dc24-1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 11/22/2024] [Indexed: 01/24/2025]
Abstract
OBJECTIVE To provide an updated synthesis on effects of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) on weight, BMI, and waist circumference incorporating newer randomized controlled trials (RCTs), particularly in individuals with overweight or obesity. RESEARCH DESIGN AND METHODS We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs published from inception to 4 October 2024. The search was limited to RCTs evaluating the use of GLP-1 RAs for mean differences from baseline in weight, BMI, and waist circumference in adults with obesity or overweight with or without diabetes. Two independent reviewers performed the literature search and data extraction, resolving disagreements via consensus or third-reviewer consultation. RESULTS Forty-seven RCTs were included, with a combined cohort of 23,244 patients. GLP-1 RAs demonstrated a mean weight reduction of -4.57 kg (95% CI -5.35 to -3.78), mean BMI reduction of -2.07 kg/m2 (95% CI -2.53 to -1.62), and mean waist circumference reduction of -4.55 cm (95% CI -5.72 to -3.38) compared with placebo. This effect was consistent across diabetes status, GLP-1 RA used, and route of administration. The greatest treatment benefit appeared to favor patients who were younger, female, without diabetes, with higher baseline weight and BMI but lower baseline HbA1c, and treated over a longer duration. Limitations include substantial statistical heterogeneity, in part due to broad inclusion criteria. However, this heterogeneity may improve generalizability by reflecting a wide range of study designs and patient populations. CONCLUSIONS GLP-1 RAs demonstrated significant weight, BMI, and waist circumference reduction benefits in this meta-analysis.
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Affiliation(s)
- Hon Jen Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Sim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Hao Teo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Yao Neng Teo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Pei Chia Eng
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, U.K
| | - Mayank Dalakoti
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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Nagakura Y, Yamaki F, Saimaru H, Kase Y. Determination of Lifestyle Habits Correlating to the Prevalence of Hypertension, Diabetes, and Dyslipidemia by the Analysis of Health-Related Questionnaire Datasets in Japanese Nationwide Open Data. Cureus 2025; 17:e77105. [PMID: 39917101 PMCID: PMC11802258 DOI: 10.7759/cureus.77105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2025] [Indexed: 02/09/2025] Open
Abstract
INTRODUCTION The National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan provides a nationwide health-related dataset based on region. This study aimed to identify lifestyle habits that correlated with the prevalence of hypertension, diabetes, and dyslipidemia by analyzing a dataset. METHODS Data from 28.9 million respondents regarding lifestyle habits were collected in the fiscal year 2020 and provided in the 8th NDB Open Data Japan. Medication status for hypertension, diabetes, and dyslipidemia was used to determine the prevalence of each disorder. Responses to lifestyle habit questions were used as lifestyle variables. Pearson's correlation coefficient (r) was calculated to determine the relationships between variables. RESULTS Lifestyle habits that had a moderate or larger correlation with the prevalence of each disorder were identified by setting the criterion |r| > 0.5. Smoking, weight gain, chewing condition, eating speed, snacking, and alcohol consumption were associated with the prevalence of hypertension. Smoking, weight gain, and chewing conditions correlated with the prevalence of diabetes. No single lifestyle habit showed correlations above the set criterion for dyslipidemia prevalence. CONCLUSION Due to the diversity of lifestyle habits of residents within each of the 47 Japanese prefectures, the prefecture-based dataset in NDB Open Data Japan is pragmatic and useful for epidemiologically investigating the association between lifestyle habits and the prevalence of disorders of interest. It would be important to raise the alarm about the lifestyle habits identified in the present study to reduce the risk of developing the corresponding disorders.
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Affiliation(s)
- Yukinori Nagakura
- Research Center for Pharmaceutical Carrier Education, Faculty of Pharmacy, Musashino University, Nishitokyo, JPN
| | - Fumiko Yamaki
- Research Center for Pharmaceutical Carrier Education, Faculty of Pharmacy, Musashino University, Nishitokyo, JPN
| | - Hiroshi Saimaru
- Research Center for Pharmaceutical Carrier Education, Faculty of Pharmacy, Musashino University, Nishitokyo, JPN
| | - Yoshio Kase
- Research Center for Pharmaceutical Carrier Education, Faculty of Pharmacy, Musashino University, Nishitokyo, JPN
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Zhang L, Shen Y, Liu H, Li W, Wang L, Zhang S, Leng J, Li W, Liang Z, Yu Z, Yang X, Hu G. Body mass index trajectories and time in target range after delivery and long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus. Diabetes Obes Metab 2025; 27:320-327. [PMID: 39431360 PMCID: PMC11620931 DOI: 10.1111/dom.16020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 09/27/2024] [Accepted: 10/04/2024] [Indexed: 10/22/2024]
Abstract
AIMS This study aims to determine whether postpartum body mass index (BMI) trajectories and its time in target range (TTR) are associated with long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM). MATERIALS AND METHODS The present study included 1057 women with a history of GDM who participated in the Tianjin Gestational Diabetes Mellitus Prevention Program (TGDMPP). Oral glucose tolerance tests or physician-diagnosed information were used to diagnose type 2 diabetes after a median follow-up period of 8.47 years. Latent class modelling was applied to identify trajectories of BMI after delivery. TTR was defined as the proportion of time that BMI was within the standard range (18.5 ≤ BMI < 24.0 kg/m2). The associations of BMI trajectories and TTR with type 2 diabetes risk were analysed using multivariable Cox modelling. RESULTS Five distinct trajectories of postpartum BMI were identified. Compared with low-stable class, the multivariable-adjusted hazard ratios of type 2 diabetes were 2.02 (95% confidence interval 0.99-4.10) for median-stable class, 3.01 (1.17-7.73) for high-stable class, 2.15 (0.63-7.38) for U-shape class and 7.15 (2.08-24.5) for inverse U-shape class (p for trend = 0.012), respectively. Multivariable-adjusted hazard ratios of type 2 diabetes associated with postpartum BMI TTR of 100%, >43.4%-<100%, >0%-≤43.4% and 0% were 1.00, 1.84 (0.72-4.73), 2.75 (1.23-6.15) and 2.31 (1.05-5.08) (p for trend = 0.039), respectively. CONCLUSIONS Postpartum BMI trajectories of high-stable and inverse U-shape class as well as lower TTR were associated with an increased risk of type 2 diabetes among women with a history of GDM. Reducing BMI to a normal range in the early postpartum period and maintaining stable over time could attenuate the development of long-term type 2 diabetes.
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Affiliation(s)
- Lixia Zhang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Department of Obstetrical, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Huikun Liu
- Tianjin Women and Children’s Health Center, Tianjin, China
| | - Weiqin Li
- Tianjin Women and Children’s Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women and Children’s Health Center, Tianjin, China
| | - Shuang Zhang
- Tianjin Women and Children’s Health Center, Tianjin, China
| | - Junhong Leng
- Tianjin Women and Children’s Health Center, Tianjin, China
| | - Wei Li
- Tianjin Women and Children’s Health Center, Tianjin, China
| | - Zhaoxia Liang
- Department of Obstetrical, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Blüher M. Understanding Adipose Tissue Dysfunction. J Obes Metab Syndr 2024; 33:275-288. [PMID: 39734091 PMCID: PMC11704217 DOI: 10.7570/jomes24013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/08/2024] [Accepted: 12/16/2024] [Indexed: 12/31/2024] Open
Abstract
Diseases affecting adipose tissue (AT) function include obesity, lipodystrophy, and lipedema, among others. Both a lack of and excess AT are associated with increased risk for developing diseases including type 2 diabetes mellitus, hypertension, obstructive sleep apnea, and some types of cancer. However, individual risk of developing cardiometabolic and other 'obesity-related' diseases is not entirely determined by fat mass. Rather than excess fat accumulation, AT dysfunction may represent the mechanistic link between obesity and comorbid diseases. There are people who remain metabolically healthy despite obesity, whereas people with normal weight or very low subcutaneous AT mass may develop typically obesity-related diseases. AT dysfunction is characterized by adipocyte hypertrophy, impaired subcutaneous AT expandability (ectopic fat deposition), hypoxia, a variety of stress, inflammatory processes, and the release of proinflammatory, diabetogenic, and atherogenic signals. Genetic and environmental factors might contribute to AT heterogeneity either alone or via interaction with intrinsic biological factors. However, many questions remain regarding the mechanisms of AT dysfunction initiation and whether and how it could be reversed. Do AT signatures define clinically relevant subtypes of obesity? Is the cellular composition of AT associated with variation in obesity phenotypes? What roles do environmental compounds play in the manifestation of AT dysfunction? Answers to these and other questions may explain AT disease mechanisms and help to define strategies for improving AT health. This review focuses on recent advances in our understanding of AT biology.
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Affiliation(s)
- Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
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Pelczyńska M, Moszak M, Wojciechowska J, Płócienniczak A, Potocki J, Blok J, Balcerzak J, Zblewski M, Bogdański P. The Role of the Chronotype in Developing an Excessive Body Weight and Its Complications-A Narrative Review. Nutrients 2024; 17:80. [PMID: 39796515 PMCID: PMC11723089 DOI: 10.3390/nu17010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 12/23/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
The chronotype, the personal predisposition towards morning or evening activities, significantly influences health conditions, sleep, and eating regulations. Individuals with evening chronotypes are often at a higher risk for weight gain due to misalignment between their natural tendencies of functioning and social schedules, resulting in insufficient sleep, disruptions in eating habits, and decreased physical activity levels. Often, impaired glucose tolerance and changes in melatonin, adiponectin, and leptin secretion, along with alterations in the clock gene functions in subjects with evening preferences, may be predisposed to obesity. These disturbances contribute to metabolic dysregulation, which may lead to the subsequent onset of obesity complications, such as hypertension, type 2 diabetes, sleep apnea, and liver diseases. Targeting critical components of the circadian system and synchronizing people's chronotypes with lifestyle conditions could deliver potential strategies for preventing and treating metabolic disorders. Thus, it is recommended to take a personalized chronobiological approach to maintain a normal body weight and metabolic health. Nevertheless, future studies are needed to identify the clear mechanisms between the chronotype and human health. This article provides a narrative review and discussion of recent data to summarize studies on the circadian rhythm in the context of obesity. The manuscript represents a comprehensive overview conducted between August and November 2024 using the National Library of Medicine browser (Medline, Pub-Med, Web of Science).
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Affiliation(s)
- Marta Pelczyńska
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland; (M.M.); (P.B.)
| | - Małgorzata Moszak
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland; (M.M.); (P.B.)
| | - Julita Wojciechowska
- Faculty of Medicine, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland; (J.W.); (A.P.); (J.P.); (J.B.); (J.B.); (M.Z.)
| | - Anita Płócienniczak
- Faculty of Medicine, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland; (J.W.); (A.P.); (J.P.); (J.B.); (J.B.); (M.Z.)
| | - Jan Potocki
- Faculty of Medicine, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland; (J.W.); (A.P.); (J.P.); (J.B.); (J.B.); (M.Z.)
| | - Joanna Blok
- Faculty of Medicine, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland; (J.W.); (A.P.); (J.P.); (J.B.); (J.B.); (M.Z.)
| | - Julia Balcerzak
- Faculty of Medicine, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland; (J.W.); (A.P.); (J.P.); (J.B.); (J.B.); (M.Z.)
| | - Mikołaj Zblewski
- Faculty of Medicine, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland; (J.W.); (A.P.); (J.P.); (J.B.); (J.B.); (M.Z.)
| | - Paweł Bogdański
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland; (M.M.); (P.B.)
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Zhu L, He J. Morin Ameliorates Myocardial Injury in Diabetic Rats via Modulation of Autophagy, Apoptosis, Inflammation, and Oxidative Stress. Diabetes Metab Syndr Obes 2024; 17:4867-4882. [PMID: 39742288 PMCID: PMC11687097 DOI: 10.2147/dmso.s476867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 11/07/2024] [Indexed: 01/03/2025] Open
Abstract
Background Morin is a flavonol with beneficial effects on diabetic-related injuries. However, the effect of morin on diabetic cardiomyopathy and its association with autophagy, apoptosis, inflammation, and oxidative stress remains unclear. The current study aimed to reveal the mechanisms underlying morin-mediated protection against cardiac failure in diabetic rats. Methods Diabetic cardiomyopathy in albino Wistar rats was induced by streptozotocin (STZ). After treatment with a dose of 25, 50, and 100 mg/kg/day orally for the next 60 days, autophagic (p62, LC3, and BECN1), apoptotic (BCL2, CASP-3, and CASP9), inflammatory (IL-1β, IL-6, TNF-α), and oxidative stress (CAT, SOD, and MDA) markers in protein and gene levels as well as cardiac function tests were measured. Results The findings revealed that long-term morin treatment improved weight gain, lipid and glycemic profile, hypertension, and cardiac hypertrophy and fibrosis in diabetic rats compared to controls (p-value<0.001). Moreover, the upregulation of BCL-2, LC3, and BECN1 along with the downregulation of p62, CASP-3, and CASP-9 revealed that morin suppressed apoptosis and promoted autophagy in the cardiac tissue of rats with diabetes (p-value<0.05). Additionally, the reduction in IL-1β, IL-6, TNF-α, and MDA levels and the increment of SOD and CAT activity suggested that morin decreased inflammation and apoptosis in the heart of the rat models of diabetes (p-value<0.01). Conclusion These results may highlight the potential properties of morin as a therapeutic strategy for diabetic cardiomyopathy.
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Affiliation(s)
- Liping Zhu
- Department of Endocrinology, Huaihe Hospital of Henan University, Kaifeng, 475000, People’s Republic of China
| | - Jizhong He
- Department of Cardiology, Yan’an People’s Hospital, Yan’an, 716000, People’s Republic of China
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de Luis Román D, Primo D, Izaola Jáuregui O, Rico Bigues D, López Gómez JJ. Weight-adjusted waist index predicts metabolic syndrome in Caucasian patients with obesity. NUTR HOSP 2024; 41:1217-1223. [PMID: 39311015 DOI: 10.20960/nh.05234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024] Open
Abstract
Introduction Background and aims: the usefulness of the weight-adjusted waist index (WWI) among persons with metabolic syndrome (MS) has not been previously evaluated. The objective of this study was to evaluate the ability of WWI to predict MS in a Caucasian population with obesity. Methods: we conducted a cross sectional study in 2162 Caucasian patients with obesity. Anthropometric data (weight, height, body mass index [BMI], waist circumference, [WWI]), bioimpedanciometer parameters (total fat mass [FM], skeletal muscle mass [SMM] and skeletal muscle mass index [SMMi]), blood pressure, presence of MS and biochemical parameters were recorded and compared by tertiles of WWI. Results: a total of 1,176 subjects had MS (54.4 %) and 986 did not show MS (45.6 %). Compared with the lowest WWI category Q1 (< 11.24 cm/√kg), the prevalence of MS increased in the logistic regression model adjusted by sex and age in the Q3 group (OR = 2.53, 95 % CI = 1.71-3.23; p = 0.001). In addition, the prevalence of MS was higher in the Q3 group than in Q2 (OR = 1.65, 95 % CI = 1.25-2.17; p = 0.005). Finally, the prevalence of MS in Q2 was higher than in the Q1 group (OR = 1.21, 95 % CI = 1.06-3.11; p = 0.01). The area under the curve (AUC) to assess the ability of WWI to identify MS showed values of 0.811 (0.687-0.871; p = 0.001). The cut-off point according to the Youden index was 11.59, with sensitivity and specificity of 70 % and 93.4 %, respectively. Conclusion: we described a good accuracy of WWI to identify MS an independent association between WWI in Caucasian patients with obesity.
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Affiliation(s)
- Daniel de Luis Román
- Centro de Investigación en Endocrinología y Nutrición Clínica (IENVA). Facultad de Medicina. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario. Universidad de Valladolid
| | - David Primo
- Centro de Investigación en Endocrinología y Nutrición Clínica (IENVA). Facultad de Medicina. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario. Universidad de Valladolid
| | - Olatz Izaola Jáuregui
- Centro de Investigación en Endocrinología y Nutrición Clínica (IENVA). Facultad de Medicina. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario. Universidad de Valladolid
| | - Daniel Rico Bigues
- Centro de Investigación de Endocrinología y Nutrición Clínica de Valladolid (IENVA). Facultad de Medicina. Universidad de Valladolid
| | - Juan José López Gómez
- Centro de Investigación de Endocrinología y Nutrición Clínica de Valladolid (IENVA). Facultad de Medicina. Universidad de Valladolid
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11
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Hsu TC, Chiang CH, Liu IH, Wang CY, Chen CY. Long-Term Yo-Yo Dieting Exaggerates Liver Steatosis and Lesions but Preserves Muscle Performance in Male Zebrafish. Int J Mol Sci 2024; 25:13225. [PMID: 39684936 DOI: 10.3390/ijms252313225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 12/06/2024] [Accepted: 12/06/2024] [Indexed: 12/18/2024] Open
Abstract
Weight regain within one year after weight loss is frequently observed and is referred to as yo-yo dieting or weight cycling. In this study, we explore the effects of yo-yo dieting on the liver, adipose tissue, and muscle characteristics of male zebrafish. Four-month-old AB wild-type male zebrafish were randomly assigned to three groups: high-calorie intake (H, seven meals per day), low-calorie intake (L, two meals per day), and yo-yo diet (the low- and high-calorie alternation switched every two weeks) groups. Feeding the fish the H diet for over 8 weeks led to steatosis and damage to the liver. The yo-yo diet reduced liver lipid accumulation at week eight but caused a similar degree of lipid accumulation as the H diet thereafter. It was found that twenty weeks of yo-yo dieting actually exacerbated hepatic damage. Compared to the L diet, feeding the fish on the yo-yo and H diets for a period of 20 weeks significantly increased the size of muscle fibers, resulting in higher speed during burst swimming and a significant increase in the size and number of adipocytes in the abdominal tissue. To summarize, short-term yo-yo dieting was found to attenuate hepatosteatosis and maintain fast-twitch muscle function. Long-term yo-yo dieting preserved fast-twitch muscle function and muscle fiber size; however, it exacerbated the pathological changes in the liver.
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Affiliation(s)
- Tzu-Chieh Hsu
- Department of Animal Science and Technology, National Taiwan University, Taipei 10672, Taiwan
| | - Chun-Hsien Chiang
- Department of Animal Science and Technology, National Taiwan University, Taipei 10672, Taiwan
| | - I-Hsuan Liu
- Department of Animal Science and Technology, National Taiwan University, Taipei 10672, Taiwan
| | - Chih-Yun Wang
- Department of Animal Science and Technology, National Taiwan University, Taipei 10672, Taiwan
| | - Ching-Yi Chen
- Department of Animal Science and Technology, National Taiwan University, Taipei 10672, Taiwan
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12
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Sobhy M, Eletriby A, Ragy H, Kandil H, Saleh MA, Farag N, Guindy R, Bendary A, Nayel AME, Shawky A, Khairy A, Mortada A, Zarif B, Badran H, Khorshid H, Mahmoud K, Said K, Leon K, Abdelsabour M, Tawfik M, Abdelmegid MAKF, Koriem M, Loutfi M, Wadie M, Elnoamany M, Sadaka M, Seleem M, Zahran M, Amin OA, Elkaffas S, Ayad S, Kilany WE, Ammar W, Elawady W, Elhammady W, Abdelhady Y. ACE Inhibitors and Angiotensin Receptor Blockers for the Primary and Secondary Prevention of Cardiovascular Outcomes: Recommendations from the 2024 Egyptian Cardiology Expert Consensus in Collaboration with the CVREP Foundation. Cardiol Ther 2024; 13:707-736. [PMID: 39455534 DOI: 10.1007/s40119-024-00381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/23/2024] [Indexed: 10/28/2024] Open
Abstract
INTRODUCTION The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in regulating blood pressure (BP), with dysregulation of RAAS resulting in hypertension and potentially heart failure (HF), myocardial infarction (MI), cardio-renal syndrome, and stroke. RAAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs), have advantages beyond BP control. However, differences between these two drug classes need to be considered when choosing a therapy for preventing cardiovascular events. METHODS A panel of 36 Egyptian cardiologists developed consensus statements on RAAS inhibitors for primary and secondary prevention of cardiovascular outcomes and stroke, using a modified three-step Delphi process. RESULTS The consensus statements highlight the importance of effective BP control and the role of RAAS blockade for prevention and management of various cardiovascular diseases. ACEis and ARBs differ in their mode of action and, thus, clinical effects. On the basis of available evidence, the consensus group recommended the following: ACEis should be considered as first choice (in preference to ARBs) to reduce the risk of MI, for primary prevention of HF, and for secondary prevention of stroke. ACEis and ARBs show equivalent efficacy for the primary prevention of stroke. Evidence also favors the preferential use of ACEis in patients with type 2 diabetes, for BP control, for the primary prevention of diabetic kidney disease, and to reduce the risk of major cardiovascular and renal outcomes. Treatment with an ACEi should be started within 24 h of ST segment elevation MI (and continued long term) in patients with HF, left ventricular systolic dysfunction, and/or diabetes. Angiotensin receptor/neprilysin inhibitors (ARNIs) are the first choice for patients with HF and reduced ejection fraction, with ACEis being the second choice in this group. ARBs are indicated as alternatives in patients who cannot tolerate ACEis. ACEis may be associated with cough development, but the incidence tends to be overestimated, and the risk can be reduced by use of a lipophilic ACEi or combining the ACEi with a calcium channel blocker. CONCLUSION RAAS blockade is an essential component of hypertension therapy; however, the protective effects provided by ACEis are superior to those of ARBs. Therefore, an ACEi is indicated in almost all cases, unless not tolerated.
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Affiliation(s)
- Mohamed Sobhy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt.
- ICC Hospital, 24 Al Ghatwary Street, Smouha, Alexandria, 21648, Egypt.
| | - Adel Eletriby
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Ragy
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Hossam Kandil
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Ayman Saleh
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nabil Farag
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramez Guindy
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Bendary
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | | | - Ahmed Shawky
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Khairy
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Mortada
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Bassem Zarif
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Haitham Badran
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hazem Khorshid
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Kareem Mahmoud
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim Said
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled Leon
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Mahmoud Abdelsabour
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mazen Tawfik
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Koriem
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Loutfi
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt
| | - Moheb Wadie
- Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elnoamany
- Department of Cardiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Sadaka
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt
| | - Mohamed Seleem
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Mohamed Zahran
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Osama A Amin
- Department of Cardiology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Sameh Elkaffas
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherif Ayad
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt
| | - Wael El Kilany
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Walid Ammar
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Waleed Elawady
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Walid Elhammady
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasser Abdelhady
- Department of Cardiology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Lyngbæk MPP, Legaard GE, Nielsen NS, Durrer C, Almdal TP, Lund MAV, Liebetrau B, Ewertsen C, Lauridsen C, Solomon TPJ, Karstoft K, Pedersen BK, Ried-Larsen M. Effects of caloric restriction with different doses of exercise on fat loss in people living with type 2 diabetes: A secondary analysis of the DOSE-EX randomized clinical trial. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 14:100999. [PMID: 39427878 PMCID: PMC11964559 DOI: 10.1016/j.jshs.2024.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/02/2024] [Accepted: 06/29/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Fat loss mainly conveys the benefits of caloric restriction for people living with type 2 diabetes. The literature is equivocal regarding whether exercise facilitates fat loss during caloric restriction. This analysis aimed to assess the dose-response effects of exercise in combination with a caloric restriction on fat mass (FM) and FM percentage (FM%) in persons with diagnosed type 2 diabetes. METHODS In this secondary analysis of a 4-armed randomized trial, 82 persons living with type 2 diabetes were randomly allocated to the control group (CON) (n = 21), diet control (DCON) (25% caloric restriction; n = 20), diet control and exercise 3 times per week (MED) (n = 20), or diet control and exercise 6 times per week (HED) (n = 21) for 16 weeks. The primary analysis was the change in FM% points. Secondary analyses included fat-free mass and visceral adipose tissue (VAT) volume (cm3). RESULTS FM% decreased compared to CON by a mean difference of -3.5% (95% confidence interval (95%CI): -5.6% to -1.4%), -6.3% (95%CI: -8.4% to -4.1%), and -8.0% (95%CI: -10.2% to -5.8%) for DCON, MED, and HED, respectively. Compared to DCON, MED, and HED decreased FM% by -2.8% (95%CI: -4.9% to -0.7%) and -4.5% (95%CI: -6.6% to -2.4%), respectively. The difference in FM% between HED and MED was -1.8% (95%CI: -3.9% to 0.4%). DCON and MED decreased fat-free mass compared to CON, whereas HED preserved fat-free mass (-0.2%; 95%CI: -2.0% to 1.7%). Compared to CON, VAT volume decreased by -666.0 cm3 (95%CI: -912.8 cm3 to -385.1 cm3), -1264.0 cm3 (95%CI: -1679.6 cm3 to -655.9 cm3), and -1786.4 cm3 (95%CI: -2264.6 cm3 to -1321.2 cm3) more for DCON, MED, and HED, respectively. HED decreased VAT volume more than DCON (-1120.4 cm3; 95%CI: -1746.6 cm3 to -639.4 cm3) while the remaining comparisons did not reveal any differences. CONCLUSION All interventions were superior in reducing FM% compared to standard care. Adding exercise to a caloric restriction was superior in reducing FM% compared to a caloric restriction alone.
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Affiliation(s)
- Mark P P Lyngbæk
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark
| | - Grit E Legaard
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark
| | - Nina S Nielsen
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark
| | - Cody Durrer
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark
| | - Thomas P Almdal
- Department of Endocrinology, University of Copenhagen-Rigshospitalet, Copenhagen 2100, Denmark; Department of Immunology & Microbiology, University of Copenhagen, Copenhagen 2200, Denmark
| | - Morten Asp Vonsild Lund
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark; Department of Cardiology, University Hospital Copenhagen-Rigshospitalet, Copenhagen 2100, Denmark; The Children's Obesity Clinic, Department of Pediatrics, Holbæk Hospital, Holbæk 4300, Denmark
| | - Benedikte Liebetrau
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark
| | - Carsten Lauridsen
- Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark; Bachelor's Degree Programme in Radiography, Copenhagen University College, Copenhagen 1799, Denmark
| | | | - Kristian Karstoft
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark; Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen 2400, Denmark
| | - Bente K Pedersen
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen 2100, Denmark.
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14
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Dong DB, Qiao XL, Chen CW, Bao W, Chen CW, Yuan X, Zhang Y. The predictive value of estimated pulse wave velocity (ePWV) combined with BMI for newly diagnosed diabetes. Rev Clin Esp 2024; 224:503-509. [PMID: 38972634 DOI: 10.1016/j.rceng.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
PURPOSE Estimated pulse wave velocity (ePWV) and body mass index (BMI) are significant predictors of new-onset diabetes. This study aims to evaluate the impact and predictive value of combining ePWV and BMI on the incidence of new-onset diabetes. METHODS A secondary analysis was conducted on a cohort study by Rich Healthcare (China), involving 211,833 eligible participants. Logistic regression analysis identified factors influencing diabetes occurrence, while ROC curve analysis assessed the predictive value of ePWV, BMI, and their combination for new-onset diabetes. RESULTS Over a mean follow-up period of 3.12 years, 3,000 men (1.41%) and 1,174 women (0.55%) were diagnosed with diabetes. Logistic regression revealed that BMI, triglycerides, alanine aminotransferase, blood urea nitrogen, creatinine clearance rate, ePWV, and family history of diabetes are high-risk factors for new-onset diabetes. The combination of ePWV and BMI provided a higher area under the ROC curve (0.822) compared to ePWV or BMI alone. CONCLUSION Elevated levels of ePWV and BMI are independent risk factors for new-onset diabetes. Combining these measures enhances predictive accuracy compared to using either indicator alone.
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Affiliation(s)
- Da Bao Dong
- Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiao Li Qiao
- Department of Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Cheng Wen Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Bao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chun Wei Chen
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xiang Yuan
- Department of Emergency Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ying Zhang
- Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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15
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M JN, Bharadwaj D. The complex web of obesity: from genetics to precision medicine. Expert Rev Endocrinol Metab 2024; 19:403-418. [PMID: 38869356 DOI: 10.1080/17446651.2024.2365785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Obesity is a growing public health concern affecting both children and adults. Since it involves both genetic and environmental components, the management of obesity requires both, an understanding of the underlying genetics and changes in lifestyle. The knowledge of obesity genetics will enable the possibility of precision medicine in anti-obesity medications. AREAS COVERED Here, we explore health complications and the prevalence of obesity. We discuss disruptions in energy balance as a symptom of obesity, examining evolutionary theories, its multi-factorial origins, and heritability. Additionally, we discuss monogenic and polygenic obesity, the converging biological pathways, potential pharmacogenomics applications, and existing anti-obesity medications - specifically focussing on the leptin-melanocortin and incretin pathways. Comparisons between childhood and adult obesity genetics are made, along with insights into structural variants, epigenetic changes, and environmental influences on epigenetic signatures. EXPERT OPINION With recent advancements in anti-obesity drugs, genetic studies pinpoint new targets and allow for repurposing existing drugs. This creates opportunities for genotype-informed treatment options. Also, lifestyle interventions can help in the prevention and treatment of obesity by altering the epigenetic signatures. The comparison of genetic architecture in adults and children revealed a significant overlap. However, more robust studies with diverse ethnic representation is required in childhood obesity.
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Affiliation(s)
- Janaki Nair M
- Systems Genomics Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Dwaipayan Bharadwaj
- Systems Genomics Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
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16
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Fuller T, Newberry Z, Nasir M, Tondt J. Obesity. Prim Care 2024; 51:511-522. [PMID: 39067975 DOI: 10.1016/j.pop.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Obesity is a complex, multifactorial disease that is highly prevalent in the United States. Obesity is typically classified by body mass index and the US Preventive Services Task Force recommends screening all patients 6 years or older for obesity. Evaluation includes a thorough history and physical examination as well as laboratory tests including hemoglobin A1c, comprehensive metabolic panel, lipid panel, and thyroid-stimulating hormone. Treatment involves a multidisciplinary approach including nutrition, physical activity, and behavioral therapy as well as pharmacotherapy and bariatric surgery when appropriate.
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Affiliation(s)
- Tyler Fuller
- Department of Family and Community Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Zakary Newberry
- Department of Family and Community Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Munima Nasir
- Department of Family and Community Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Justin Tondt
- Department of Family and Community Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, 700 HMC Crescent Road, Hershey, PA 17033, USA.
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17
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Zhang F, Chen J, Han A, Li D, Zhu W. The effects of fine particulate matter, solid fuel use and greenness on the risks of diabetes in middle-aged and older Chinese. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:780-786. [PMID: 37169800 DOI: 10.1038/s41370-023-00551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Previous studies provided clues that environmental factors were closely related to diabetes incidence. However, the evidence from high-quality and large cohort studies about the effects of PM2.5, solid fuel use and greenness on the development of diabetes among middle-aged and older adults in China was scarce. OBJECTIVE To separately investigate the independent effects of PM2.5, solid fuel use and greenness on the development of diabetes among middle-aged and older adults. METHODS A total of 9242 participants were involved in this study extracted from the China Health and Retirement Longitudinal Study. Time-varying Cox regression was applied to detect the association of diabetes with PM2.5, solid fuel use and greenness, separately. The potential interactive effect of air pollution and greenness were explored using the relative excess risk due to interaction (RERI). RESULTS Per 10 μg/m3 increases in PM2.5 were associated with 6.0% (95% CI: 1.9, 10.2) increasing risks of diabetes incidence. Females seemed to be more susceptible to PM2.5. However, the effects of solid fuel use only existed in older and lower BMI populations, with hazard ratios (HRs) of 1.404 (1.116, 1.766) and 1.346 (1.057, 1.715), respectively. In addition, exposure to high-level greenness might reduce the risks of developing diabetes [HR = 0.801 (0.687, 0.934)]. Weak evidence of the interaction effect of PM2.5/solid fuel use and greenness on diabetes was found. SIGNIFICANCE Both PM2.5 and solid fuel use were associated with the increasing incidence of diabetes. In addition, high-level greenness might be a beneficial environmental factor for reducing the risks of developing diabetes. All in all, our findings might provide valuable references for public health apartments to formulate very fruitful policies to reduce the burden of diabetes. IMPACT STATEMENT Both PM2.5 and solid fuel use were associated with the increasing incidence of diabetes while high-level greenness was not, which might provide valuable references for public health apartments to make policies.
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Affiliation(s)
- Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Jiahao Chen
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Aojing Han
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Dejia Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
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18
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Mirzadeh P, Kuk JL, Wharton S, Ardern CI. Overweight and obesity code (E66) trends and predictors in Canada: Cross-sectional analysis of Discharge Abstract Data (DAD), 2018-2022. Obes Res Clin Pract 2024; 18:322-327. [PMID: 39353811 DOI: 10.1016/j.orcp.2024.09.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 09/10/2024] [Accepted: 09/25/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION Since the adoption of billing codes for obesity, few studies have examined their use in administrative healthcare data. Of those that have, analyses have been limited to examinations of coding validity and trends among persons diagnosed with obesity (ICD-10, E66 code). This study aimed to explore the prevalence and predictors in E66 use across Canada two years prior to, and after the onset of Covid-19. METHODS This secondary analysis used the 2018-2022 Discharge Abstract Dataset of the Canadian Institute for Health Information. The sample consists of 166,335 individuals 20 to 64 years old across all provinces/territories, excluding Québec. Prevalence of E66 was assessed for each province, and multivariable logistic regression analysis was used to estimate the odds of E66 coding. RESULTS Regional variations were present in E66 use, with Manitoba having the highest prevalence of coding. Of those with a E66 code, 98.7 % were within the obesity BMI category. In general, females of higher age, with one or more comorbidities, and shorter length of stay had higher odds of receiving the E66 code. Odds of E66 coding were also lower in females after the onset of Covid-19, whereas in males, only those with shorter length of hospital stay had consistently higher odds of diagnosis. CONCLUSION This study offers new insight into E66 use across Canada, and points to the need for consistent acquisition of weight and height information, and the use of E66 coding within existing electronic medical records systems to inform inter-provincial care gaps for obesity-related care.
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Affiliation(s)
- Parmis Mirzadeh
- York University, School of Kinesiology and Health Science, Toronto, Canada.
| | - Jennifer L Kuk
- York University, School of Kinesiology and Health Science, Toronto, Canada
| | - Sean Wharton
- York University, School of Kinesiology and Health Science, Toronto, Canada; Wharton Medical Clinic, Toronto, Canada
| | - Chris I Ardern
- York University, School of Kinesiology and Health Science, Toronto, Canada
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19
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Rippe JM. The Academic Basis of Lifestyle Medicine. Am J Lifestyle Med 2024; 18:497-511. [PMID: 39262885 PMCID: PMC11384844 DOI: 10.1177/15598276231212825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
There is no longer any serious doubt that daily habits and actions profoundly impact on both short- and long-term health and quality of life. An overwhelming body of scientific and medical literature supports this contention. Thousands of studies support the concept that regular physical activity, healthy nutrition and maintaining a healthy body weight, not smoking cigarettes, obtaining healthy sleep, reducing stress and maintaining positive connections with other individuals all profoundly impact on health. The scientific literature the supports the health impact of these daily habits and actions is underscored by its incorporation into virtually every evidence-based clinical guideline in the area of metabolic diseases. Thus, the scientific basis for lifestyle medicine rests on an enormous body of evidence-based literature. The key issue in lifestyle medicine is to provide an overall framework where these studies, which are often spread over scientific literature in multiple disciplines, can be made accessible to the medical community and to the public at large. This is the essence of the field of lifestyle medicine. The academic basis of lifestyle medicine is robust and needs to be emphasized by all practitioners of lifestyle medicine. This is the key to moving this field forward into the future.
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Affiliation(s)
- James M. Rippe
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA (JMR)
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20
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Lin W, Alfheeaid HA, Alasqah I, Alqarawi N, Alotaibi SA, Alribdi FF, Almutairi S, Lima MJ, Teixeira-Lemos E, Raposo A. Dietary Patterns among Smokers and Non-Smokers: Findings from the National Health and Nutritional Examination Survey (NHANES) 2017-2018. Nutrients 2024; 16:2035. [PMID: 38999783 PMCID: PMC11243715 DOI: 10.3390/nu16132035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Diet behavior and nutrition are critical for maintaining health and improving quality of life. Cigarette smoking remains the leading cause of preventable death in the United States. Poor dietary choices, such as excessively frequenting restaurants, consuming ready-to-eat foods from grocery stores, and ingesting ultra-processed foods (like frozen meals and pizzas), can adversely impact health. Despite this, research comparing dietary behaviors between smokers and non-smokers is limited. Using data from the National Health and Nutritional Examination Survey 2017-2018, we analyzed diet behavior based on smoking status. Our findings reveal that smokers had a significant increase (90%) in the frequency of consuming frozen meals/pizzas in the past 30 days compared to non-smokers (coefficient: 1.9; 95% CI: 1.4, 2.6; p-value < 0.001). Additionally, over 70% of participants, regardless of their smoking status, were unaware of MyPlate, a nutritional guide created by the United States Department of Agriculture (USDA) to encourage Americans to make healthier food choices. There is an urgent need to increase public awareness of MyPlate and promote a better understanding of healthy dietary behaviors.
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Affiliation(s)
- Wenxue Lin
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA
| | - Hani A. Alfheeaid
- Department of Food Science and Human Nutrition, College of Agriculture and Food, Qassim University, Buraydah 51452, Saudi Arabia;
| | - Ibrahim Alasqah
- Department of Community, Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraydah 51452, Saudi Arabia; (I.A.); (N.A.)
- School of Health, University of New England, Armidale, NSW 2351, Australia
| | - Nada Alqarawi
- Department of Community, Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraydah 51452, Saudi Arabia; (I.A.); (N.A.)
| | - Saad Abdullah Alotaibi
- Department of Public Health, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia;
| | | | - Sulaiman Almutairi
- Department of Health Informatics, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia;
| | - Maria João Lima
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (M.J.L.); (E.T.-L.)
| | - Edite Teixeira-Lemos
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (M.J.L.); (E.T.-L.)
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
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21
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Nkhata SG, Chibwana G. Menus prescribed for diabetes management by Malawian referral hospitals are loaded with calories from carbohydrates and may worsen diabetes condition. Nutr Health 2024; 30:361-369. [PMID: 35934975 DOI: 10.1177/02601060221119248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Management of diabetes demands reduction of carbohydrates and moderation of total calories, fats and protein to promote weight loss while controlling postprandial blood glucose. Hospitals prescribe menus to diabetic patients to achieve these reasons. Whether these menus provide meals that help improve diabetes outcome remains unknown. Aim: Therefore, this study assessed six menus from six different referral hospitals in Malawi. Method: We formulated three separate diets (n = 3) encompassing breakfast, 10 am snack, lunch, 3 pm snack and super that a diabetic person would consume in a day as prescribed by each menu. We developed nutritionally adequate meals based on foods listed on the menu. We calculated, using the Malawi Food Composition Table (MFCT), total available carbohydrates, energy, protein, total fats, SAFA, MUFA and PUFA that each diet provides. We averaged the nutrient content from the three diets. Results: Menus from QECH and ST Joseph Mission Hospital provide significantly higher total carbohydrates (p = 0.001), total energy (p = 0.000) and fats (p = 0.01) but contain similar proteins (p = 0.761). The proportion of energy from carbohydrates for all the menus is very high and ranges from 68-81% while protein and fat proportions are lower and range from 7-16% and 7-20%, respectively. Conclusion: These menus have high propensity to increase postprandial blood glucose and promote weight gain that could be harmful to a diabetic person. All the menus deviate from a somehow recommended energy contribution of approximately 50:25:25 from carbohydrates, fat and protein, respectively.
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Affiliation(s)
- Smith G Nkhata
- Food Processing and Nutrition, Department of Agriculture and Food Systems, Faculty of Life Sciences and Natural Resources, Natural Resources College, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
- Food Technology, Department of Agriculture and Food Systems, Faculty of Life Sciences and Natural Resources, Natural Resources College, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Gracian Chibwana
- Food Technology, Department of Agriculture and Food Systems, Faculty of Life Sciences and Natural Resources, Natural Resources College, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
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22
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Luo Y, Liu Z, Luo J, Li R, Wei Z, Yang L, Li J, He L, Su Y, Peng X, Hu X. BMI Trajectories in Late Middle Age, Genetic Risk, and Incident Diabetes in Older Adults: Evidence From a 26-Year Longitudinal Study. Am J Epidemiol 2024; 193:685-694. [PMID: 37016424 PMCID: PMC11484589 DOI: 10.1093/aje/kwad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/16/2022] [Accepted: 04/02/2023] [Indexed: 04/06/2023] Open
Abstract
This study investigated the association between body mass index (BMI) trajectories in late middle age and incident diabetes in later years. A total of 11,441 participants aged 50-60 years from the Health and Retirement Study with at least 2 self-reported BMI records were included. Individual BMI trajectories representing average BMI changes per year were generated using multilevel modeling. Adjusted risk ratios (ARRs) and 95% confidence intervals (95% CIs) were calculated. Associations between BMI trajectories and diabetes risk in participants with different genetic risks were estimated for 5,720 participants of European ancestry. BMI trajectories were significantly associated with diabetes risk in older age (slowly increasing vs. stable: ARR = 1.31, 95% CI: 1.12, 1.54; rapidly increasing vs. stable: ARR = 1.5, 95% CI: 1.25, 1.79). This association was strongest for normal-initial-BMI participants (slowly increasing: ARR = 1.34, 95% CI: 0.96, 1.88; rapidly increasing: ARR = 2.06, 95% CI: 1.37, 3.11). Participants with a higher genetic liability to diabetes and a rapidly increasing BMI trajectory had the highest risk for diabetes (ARR = 2.15, 95% CI: 1.67, 2.76). These findings confirmed that BMI is the leading risk factor for diabetes and that although the normal BMI group has the lowest incidence rate for diabetes, people with normal BMI are most sensitive to changes in BMI.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yonglin Su
- Corresponding to Dr. Xiaolin Hu, Department of Nursing, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), PR China. (e-mail: ); Dr. Xingchen Peng, Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), People's Republic of China (e-mail: ); Dr. Yonglin Su, Department of Rehabilitation, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), People's Republic of China (e-mail: )
| | - Xingchen Peng
- Corresponding to Dr. Xiaolin Hu, Department of Nursing, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), PR China. (e-mail: ); Dr. Xingchen Peng, Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), People's Republic of China (e-mail: ); Dr. Yonglin Su, Department of Rehabilitation, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), People's Republic of China (e-mail: )
| | - Xiaolin Hu
- Corresponding to Dr. Xiaolin Hu, Department of Nursing, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), PR China. (e-mail: ); Dr. Xingchen Peng, Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), People's Republic of China (e-mail: ); Dr. Yonglin Su, Department of Rehabilitation, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan (610041), People's Republic of China (e-mail: )
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23
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Lin W. The Association between Body Mass Index and Glycohemoglobin (HbA1c) in the US Population's Diabetes Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:517. [PMID: 38791732 PMCID: PMC11121031 DOI: 10.3390/ijerph21050517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
Obesity, indicated by Body Mass Index (BMI), is a risk factor for type 2 diabetes. However, its association with glycated hemoglobin (HbA1c), a crucial indicator of blood-sugar control, may vary across different populations and disease statuses. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were analyzed. Participants aged 18-79 years with complete information on BMI, diabetes status, and HbA1c were included (n = 4003). Linear regression models were used to assess the association between BMI and HbA1c, adjusting for demographic confounders, smoking status, alcohol consumption, and healthcare access. Among participants without diabetes, BMI was positively associated with HbA1c levels (coefficient: 0.015, 95% CI: 0.01, 0.02; p-value < 0.05), after adjusting for potential confounders. However, this association was not significant among those with diabetes (coefficient: -0.005, 95% CI: -0.05, 0.04; p-value > 0.1). Our findings suggest a differential relationship between BMI and HbA1c in individuals with and without diabetes. While BMI remains a significant predictor of HbA1c in non-diabetic individuals, its significance diminishes in those with diabetes.
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Affiliation(s)
- Wenxue Lin
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA
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24
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Hobbach AJ, Feld J, Linke WA, Sindermann JR, Dröge P, Ruhnke T, Günster C, Reinecke H. BMI-Stratified Exploration of the 'Obesity Paradox': Heart Failure Perspectives from a Large German Insurance Database. J Clin Med 2024; 13:2086. [PMID: 38610851 PMCID: PMC11012389 DOI: 10.3390/jcm13072086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The global rise of obesity and its association with cardiovascular risk factors (CVRF) have highlighted its connection to chronic heart failure (CHF). Paradoxically, obese CHF patients often experience better outcomes, a phenomenon known as the 'obesity paradox'. This study evaluated the 'obesity paradox' within a large cohort in Germany and explored how varying degrees of obesity affect HF outcome. Methods: Anonymized health claims data from the largest German insurer (AOK) for the years 2014-2015 were utilized to analyze 88,247 patients hospitalized for myocardial infarction. This analysis encompassed baseline characteristics, comorbidities, interventions, complications, and long-term outcomes, including overall survival, freedom from CHF, and CHF-related rehospitalization. Patients were categorized based on body mass index. Results: Obese patients encompassed 21.3% of our cohort (median age 68.69 years); they exhibited a higher prevalence of CVRF (p < 0.001) and comorbidities than non-obese patients (median age 70.69 years). Short-term outcomes revealed lower complication rates and mortality (p < 0.001) in obese compared to non-obese patients. Kaplan-Meier estimations for long-term analysis illustrated increased incidences of CHF and rehospitalization rates among the obese, yet with lower overall mortality. Multivariable Cox regression analysis indicated that obese individuals faced a higher risk of developing CHF and being rehospitalized due to CHF but demonstrated better overall survival for those classified as having low-level obesity (p < 0.001). Conclusions: This study underscores favorable short-term outcomes among obese individuals. The 'obesity paradox' was confirmed, with more frequent CHF cases and rehospitalizations in the long term, alongside better overall survival for certain degrees of obesity.
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Affiliation(s)
- Anastasia J. Hobbach
- Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, University Hospital Münster, 48149 Münster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Münster, 48149 Münster, Germany
| | - Wolfgang A. Linke
- Institute of Physiology II, University of Münster, 48149 Münster, Germany
| | - Jürgen R. Sindermann
- Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, University Hospital Münster, 48149 Münster, Germany
| | - Patrik Dröge
- AOK Research Institute (WIdO), AOK-Bundesverband, 10178 Berlin, Germany (T.R.); (C.G.)
| | - Thomas Ruhnke
- AOK Research Institute (WIdO), AOK-Bundesverband, 10178 Berlin, Germany (T.R.); (C.G.)
| | - Christian Günster
- AOK Research Institute (WIdO), AOK-Bundesverband, 10178 Berlin, Germany (T.R.); (C.G.)
| | - Holger Reinecke
- Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, University Hospital Münster, 48149 Münster, Germany
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25
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Kleiboeker B, He A, Tan M, Lu D, Hu D, Liu X, Goodarzi P, Hsu FF, Razani B, Semenkovich CF, Lodhi IJ. Adipose tissue peroxisomal lipid synthesis orchestrates obesity and insulin resistance through LXR-dependent lipogenesis. Mol Metab 2024; 82:101913. [PMID: 38458567 PMCID: PMC10950804 DOI: 10.1016/j.molmet.2024.101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE Adipose tissue mass is maintained by a balance between lipolysis and lipid storage. The contribution of adipose tissue lipogenesis to fat mass, especially in the setting of high-fat feeding, is considered minor. Here we investigated the effect of adipose-specific inactivation of the peroxisomal lipid synthetic protein PexRAP on fatty acid synthase (FASN)-mediated lipogenesis and its impact on adiposity and metabolic homeostasis. METHODS To explore the role of PexRAP in adipose tissue, we metabolically phenotyped mice with adipose-specific knockout of PexRAP. Bulk RNA sequencing was used to determine transcriptomic responses to PexRAP deletion and 14C-malonyl CoA allowed us to measure de novo lipogenic activity in adipose tissue of these mice. In vitro cell culture models were used to elucidate the mechanism of cellular responses to PexRAP deletion. RESULTS Adipose-specific PexRAP deletion promoted diet-induced obesity and insulin resistance through activation of de novo lipogenesis. Mechanistically, PexRAP inactivation inhibited the flux of carbons to ethanolamine plasmalogens. This increased the nuclear PC/PE ratio and promoted cholesterol mislocalization, resulting in activation of liver X receptor (LXR), a nuclear receptor known to be activated by increased intracellular cholesterol. LXR activation led to increased expression of the phospholipid remodeling enzyme LPCAT3 and induced FASN-mediated lipogenesis, which promoted diet-induced obesity and insulin resistance. CONCLUSIONS These studies reveal an unexpected role for peroxisome-derived lipids in regulating LXR-dependent lipogenesis and suggest that activation of lipogenesis, combined with dietary lipid overload, exacerbates obesity and metabolic dysregulation.
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Affiliation(s)
- Brian Kleiboeker
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Anyuan He
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Min Tan
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Dongliang Lu
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Donghua Hu
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Xuejing Liu
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Parniyan Goodarzi
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Fong-Fu Hsu
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Babak Razani
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Clay F Semenkovich
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Irfan J Lodhi
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, MO 63110, USA.
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26
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Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Kelly T, Irvine K, Peters C, Zhyzhneuskaya S, Hollingsworth KG, Adamson AJ, Sniehotta FF, Mathers JC, McIlvenna Y, Welsh P, McConnachie A, McIntosh A, Sattar N, Taylor R. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes Endocrinol 2024; 12:233-246. [PMID: 38423026 DOI: 10.1016/s2213-8587(23)00385-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND In DiRECT, a randomised controlled effectiveness trial, weight management intervention after 2 years resulted in mean weight loss of 7·6 kg, with 36% of participants in remission of type 2 diabetes. Of 36 in the intervention group who maintained over 10 kg weight loss at 2 years, 29 (81%) were in remission. Continued low-intensity dietary support was then offered up to 5 years from baseline to intervention participants, aiming to maintain weight loss and gain clinical benefits. This extension study was designed to provide observed outcomes at 5 years. METHODS The DiRECT trial took place in primary care practices in the UK. Participants were individuals aged 20-65 years who had less than 6 years' duration of type 2 diabetes, a BMI greater than 27 kg/m2, and were not on insulin. The intervention consisted of withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825-853 kcal per day formula diet for 12-20 weeks), stepped food reintroduction (2-8 weeks), and then structured support for weight-loss maintenance. After sharing the 2-year results with all participants, UK National Health Service data were collected annually until year 5 from remaining intervention participants who received low-intensity dietary support, intervention withdrawals, and the original randomly allocated groups. The primary outcome was remission of type 2 diabetes; having established in the DiRECT trial that sustained weight loss was the dominant driver of remission, this was assumed for the Extension study. The trial is registered with the ISRCTN registry, number 03267836. FINDINGS Between July 25, 2014, and Aug 5, 2016, 149 participants were randomly assigned to the intervention group and 149 were assigned to the control group in the original DiRECT study. After 2 years, all intervention participants still in the trial (101 [68%] of 149) were approached to receive low-intensity support for a further 3 years. 95 (94%) of 101 were able to continue and consented and were allocated to the DiRECT extension group. 54 participants were allocated to the non-extension group, where intervention was withdrawn. At 5 years, DiRECT extension participants (n=85) lost an average of 6·1 kg, with 11 (13%) of 85 in remission. Compared with the non-extension group, DiRECT extension participants had more visits with HbA1c <48 mmol/mol (<6·5%; 36% vs 17%, p=0·0004), without glucose-lowering medication (62% vs 30%, p<0·0001), and in remission (34% vs 12%, p<0·0001). Original control participants (n=149) had mean weight loss 4·6 kg (n=82), and 5 (5%) of 93 were in remission. Compared with control participants, original intervention participants had more visits with weight more than 5% below baseline (61% vs 29%, p<0·0001), HbA1c below 48 mmol/mol (29% vs 15%, p=0·0002), without antidiabetic medication (51% vs 16%, p<0·0001), and in remission (27% vs 4%, p<0·0001). Of those in remission at year 2, 26% remained in remission at 5 years. Serious adverse events in the original intervention group (4·8 events per 100 patient-years) were under half those in the control group (10·2 per 100 patient-years, p=0·0080). INTERPRETATION The extended DiRECT intervention was associated with greater aggregated and absolute weight loss, and suggested improved health status over 5 years. FUNDING Diabetes UK.
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Affiliation(s)
- Michael Ej Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alison C Barnes
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Counterweight, London, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Tara Kelly
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Keaton Irvine
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carl Peters
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sviatlana Zhyzhneuskaya
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Centre for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - John C Mathers
- Human Nutrition Research and Exercise Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yvonne McIlvenna
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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27
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Skurk T, Bosy-Westphal A, Grünerbel A, Kabisch S, Keuthage W, Kronsbein P, Müssig K, Nussbaumer H, Pfeiffer AFH, Simon MC, Tombek A, Weber KS, Rubin D. Dietary Recommendations for Persons with Type 2 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2024; 132:182-215. [PMID: 38286422 DOI: 10.1055/a-2166-6772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- Thomas Skurk
- ZIEL Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Anja Bosy-Westphal
- Institute of Human Nutrition, Faculty of Agriculture and Nutritional Sciences, Christian-Albrechts University of Kiel, Kiel, Germany
| | | | - Stefan Kabisch
- German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | - Winfried Keuthage
- Specialist Practice for Diabetes and Nutritional Medicine, Münster, Germany
| | - Peter Kronsbein
- Faculty of Nutrition and Food Sciences, Niederrhein University of Applied Sciences, Mönchengladbach Campus, Mönchengladbach, Germany
| | - Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | | | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marie-Christine Simon
- Institute of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Astrid Tombek
- Diabetes Centre Bad Mergentheim, Bad Mergentheim, Germany
| | - Katharina S Weber
- Institute for Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Diana Rubin
- Vivantes Hospital Spandau, Berlin, Germany
- Vivantes Humboldt Hospital, Berlin, Germany
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28
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Lahlou RA, Carvalho F, Pereira MJ, Lopes J, Silva LR. Overview of Ethnobotanical-Pharmacological Studies Carried Out on Medicinal Plants from the Serra da Estrela Natural Park: Focus on Their Antidiabetic Potential. Pharmaceutics 2024; 16:454. [PMID: 38675115 PMCID: PMC11054966 DOI: 10.3390/pharmaceutics16040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
The Serra da Estrela Natural Park (NPSE) in Portugal stands out as a well-preserved region abundant in medicinal plants, particularly known for their pharmaceutical applications in diabetes prevention and treatment. This comprehensive review explores these plants' botanical diversity, traditional uses, pharmacological applications, and chemical composition. The NPSE boast a rich diversity with 138 medicinal plants across 55 families identified as traditionally and pharmacologically used against diabetes globally. Notably, the Asteraceae and Lamiaceae families are prevalent in antidiabetic applications. In vitro studies have revealed their significant inhibition of carbohydrate-metabolizing enzymes, and certain plant co-products regulate genes involved in carbohydrate metabolism and insulin secretion. In vivo trials have demonstrated antidiabetic effects, including glycaemia regulation, insulin secretion, antioxidant activity, and lipid profile modulation. Medicinal plants in NPSE exhibit various activities beyond antidiabetic, such as antioxidant, anti-inflammatory, antibacterial, anti-cancer, and more. Chemical analyses have identified over fifty compounds like phenolic acids, flavonoids, terpenoids, and polysaccharides responsible for their efficacy against diabetes. These findings underscore the potential of NPSE medicinal plants as antidiabetic candidates, urging further research to develop effective plant-based antidiabetic drugs, beverages, and supplements.
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Affiliation(s)
- Radhia Aitfella Lahlou
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (R.A.L.); (F.C.)
| | - Filomena Carvalho
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (R.A.L.); (F.C.)
| | - Maria João Pereira
- CERENA/DER, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal;
| | - João Lopes
- iMed.ULisboa, Research Institute for Medicines, Faculdade de Farmácia, University of Lisboa, 1649-003 Lisboa, Portugal;
| | - Luís R. Silva
- SPRINT Sport Physical Activity and Health Research & Innovation Center, Instituto Politécnico da Guarda, 6300-559 Guarda, Portugal; (R.A.L.); (F.C.)
- CICS-UBI—Health Sciences Research Center, University of Beira Interior, 6201-506 Covilhã, Portugal
- CERES, Department of Chemical Engineering, University of Coimbra, 3030-790 Coimbra, Portugal
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Tanaka Y, Maeda N, Koseki M, Maeda K. Changes in Body Weight in Severely Obese Patients Treated with the Anorexiant Mazindol. J Clin Med 2024; 13:1860. [PMID: 38610625 PMCID: PMC11012520 DOI: 10.3390/jcm13071860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The number of severely obese patients worldwide is rapidly increasing. Recently, novel therapeutic approaches, such as bariatric surgery or GLP-1 receptor agonists, have emerged, bringing about a paradigm shift in this field. However, these therapies sometimes face challenges, such as peri-surgical complications or supply shortages. Mazindol, which is an appetite suppressant approved decades ago in Japan, remains a valuable option. In this study, we investigated the effectiveness of mazindol in reducing body weight in 147 patients, and we examined the factors influencing said effectiveness. (2) Methods: The patients were divided into four groups based on the treatment cycles they underwent: 1 cycle, 2 cycles, 3-5 cycles, and over 6 cycles. We compared the changes in body weight before and after the treatment among these four groups. Additionally, we sought to identify the factors correlated to the effectiveness of mazindol. (3) Results: The change in body weight was more pronounced in the group which underwent 3-5 cycles compared to the groups which underwent 1 cycle and 2 cycles; this change was also more pronounced in the group which underwent over 6 cycles compared to those which underwent 1 cycle. Furthermore, we observed a significant correlation between the initial body weight and the extent of body weight change. (4) Conclusions: Mazindol demonstrated effectiveness in reducing the body weight of patients in a cycle-dependent manner.
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Affiliation(s)
| | - Norikazu Maeda
- Longwood Maeda Clinic, Suita 565-0874, Japan
- Department of Endocrinology, Metabolism and Diabetes, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Japan
| | - Masahiro Koseki
- Longwood Maeda Clinic, Suita 565-0874, Japan
- Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
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Sabah SA, Haddad EA. The Utilization of Bariatric Surgery in Patients With and Without Diabetes: Results from the Second Kuwait National Bariatric Surgery Database Report. Bariatr Surg Pract Patient Care 2024; 19:20-27. [DOI: 10.1089/bari.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Affiliation(s)
- Salman Al Sabah
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
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31
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Sulu C, Yumuk VD. Treat Obesity to Treat Type 2 Diabetes Mellitus. Diabetes Ther 2024; 15:611-622. [PMID: 38310627 PMCID: PMC10942960 DOI: 10.1007/s13300-024-01536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Obesity, a multifactorial, relapsing chronic disease, serves as a gateway to a spectrum of metabolic, cardiovascular, mechanical and mental health problems. Over the last few decades, the global prevalence of obesity has surged nearly threefold, mirroring the escalating rates of type 2 diabetes mellitus (T2DM). This parallel trajectory strongly suggests a cause-and-effect relationship between obesity and T2DM. Extensive research indicates that even modest weight gain elevates the risk of T2DM, favoring the notion of obesity being a root cause. This perspective finds robust support in numerous studies demonstrating the preventive effects of obesity management on the onset of T2DM. Beyond prevention, obesity management has been shown to enhance remission in individuals with T2DM and to decrease microvascular complications, cardiovascular risk factors, renal failure and heart failure. This evidence underpins the urgent need for global initiatives aimed at addressing obesity management as a key strategy in the prevention and management of T2DM and its complications.
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Affiliation(s)
- Cem Sulu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, No. 53, 34098, Fatih, Istanbul, Turkey
- European Association for the Study of Obesity-Collaborating Center for Obesity Management, Istanbul, Turkey
| | - Volkan Demirhan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, No. 53, 34098, Fatih, Istanbul, Turkey.
- European Association for the Study of Obesity-Collaborating Center for Obesity Management, Istanbul, Turkey.
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Lodhia NA, Hiramoto B, Horton L, Goldin AH, Thompson CC, Chan WW. Obesity Is Associated with Altered Rectal Sensitivity in Chronic Constipation. Dig Dis Sci 2024; 69:884-891. [PMID: 38184499 PMCID: PMC10961196 DOI: 10.1007/s10620-023-08246-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/15/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Defecation dysfunction may contribute to chronic constipation (CC), but the impact of obesity on anorectal physiology in CC remains unclear. We aimed to evaluate the relationship between obesity and anorectal function on physiologic testing in patients presenting with CC. METHODS This was a retrospective cohort study of consecutive adults who underwent high resolution anorectal manometry (HRAM) at a tertiary center for CC. Patient demographics, clinical history, surgical/obstetric history, medications, and HRAM results were reviewed. Patients were classified into obese (BMI > 30 kg/m2) vs non-obese (BMI < 30 kg/m2) groups at the time of HRAM. Fisher-exact/student t-test for univariate analyses and general linear regression for multivariable analysis were performed. RESULTS 383 adults (mean 50.3 years; 85.8% female) with CC were included. On HRAM, patients with obesity had lower anal sphincter resting tone (37.3 vs 48.5 mmHg, p = 0.005) and maximum squeeze pressure (104.8 mmHg vs 120.0 mmHg, p = 0.043). No significant differences in dyssynergia (61% vs 53%, p = 0.294) and failed balloon expulsion (18% vs 25%, p = 0.381) were found between obese and non-obese groups. On balloon distention testing, the maximum tolerated (163.5 vs 147.6 mL, p = 0.042) and urge sensation (113.9 vs 103.7 mL, p = 0.048) volumes were significantly increased among patients with obesity. After adjusting for potential confounders, obesity remained independently associated with increased maximum tolerated volume (β-coefficient 13.7, p = 0.049). CONCLUSION Obesity was independently associated with altered rectal sensitivity among patients with CC. Altered rectal sensation may play an important role in CC among patients with obesity. Anorectal physiology testing should be considered to understand the pathophysiology and guide management.
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Affiliation(s)
- Nayna A Lodhia
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Brent Hiramoto
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Horton
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alison H Goldin
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Shi Y, Huang X, Zeng Y, Zhai M, Yao H, Liu C, Li B, Gong S, Yu Q, Zhuang J, Zhao Y, Lu L, Zhou B, Jian W, Peng W. Endothelial TET2 regulates the white adipose browning and metabolism via fatty acid oxidation in obesity. Redox Biol 2024; 69:103013. [PMID: 38168657 PMCID: PMC10797209 DOI: 10.1016/j.redox.2023.103013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Obesity is a complex metabolic disorder, manifesting as excessive accumulation of body fat. Ten-Eleven Translocation-2 (TET2) has garnered significant attention in the context of obesity due to its crucial role in epigenetic regulation and metabolic homeostasis. In this study, we aimed to investigate the effect of endothelial TET2 on obesity and explore the potential mechanism. We generated endothelial cell-specific TET2 deficiency mice and investigated endothelial TET2 using transcriptomic and epigenomic analyses. We determined the downregulation of endothelial TET2 in white adipose tissues. Furthermore, we identified that endothelial TET2 loss aggravated high-fat diet-induced obesity by inhibiting vascularization and thus suppressing white adipose tissue browning. Mechanistically, endothelial TET2 modulates obesity by engaging in endothelial fatty acid oxidation and angiocrine-mediated secretion of bone morphogenetic protein 4 (BMP4), in which nuclear factor-erythroid 2-related factor 2 (NRF2) serves as a key mediator. Our study reveals that endothelial TET2 regulates white adipose tissue browning by interacting with NRF2 to facilitate fatty acid oxidation and lipolysis in adipocytes.
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Affiliation(s)
- Yefei Shi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinru Huang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanxi Zeng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Zhai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongyun Yao
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang Liu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Bo Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shiyu Gong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qing Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianhui Zhuang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yifan Zhao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liesheng Lu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Zhou
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weixia Jian
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wenhui Peng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Al-Horani RA, Aliter KF, Aliter HF. Future is Brighter: New Potential Paradigm-Shifting Medications and Regimens for Diabetes and Obesity. Curr Diabetes Rev 2024; 20:84-97. [PMID: 38275036 PMCID: PMC11452264 DOI: 10.2174/0115733998276832231124170324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 01/27/2024]
Abstract
Diabetes is a chronic illness that can become debilitating owing to its microvascular and macrovascular complications. Its prevalence is increasing and so is its cost. Diabetes, particularly type 2, appears to have a very close relationship with obesity. While lifestyle modifications, exercises, and current therapeutics have substantially improved clinical outcomes, the need for new therapeutics and regimens continue to exist. Several new medications and regimens for diabetes, obesity, and diabesity are showing promising results in advanced clinical trials. For type 1 diabetes mellitus (T1DM), they include teplizumab, ustekinumab, jakinibs, and cell therapies, whereas for type 2 diabetes mellitus (T2DM), they include once-weakly insulin, tirzepatide, high oral dose of semaglutide, orforglipron, retatrutide, CagriSema, and survodutide. Given their structural and mechanistic diversity as well as their substantial efficacy and safety profiles, these medications and regimens are paradigm shifting and promise a brighter future. They will likely enable better disease prevention and management. This review will provide details about each of the above strategies to keep the scientific community up to date about progress in the fields of diabetes and obesity.
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Affiliation(s)
- Rami A. Al-Horani
- Division of Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, Louisiana 70125, USA
| | - Kholoud F. Aliter
- Department of Biology and Chemistry, School of STEM, Dillard University, New Orleans, Louisiana 70122, USA
| | - Hashem F. Aliter
- Division of Cardiac Surgery, Department of Surgery, Dalhouise University, Halifax, NS B3H 3A6, Canada
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Almuraikhy S, Doudin A, Domling A, Althani AAJF, Elrayess MA. Molecular regulators of exercise-mediated insulin sensitivity in non-obese individuals. J Cell Mol Med 2024; 28:e18015. [PMID: 37938877 PMCID: PMC10805515 DOI: 10.1111/jcmm.18015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
Insulin resistance is a significant contributor to the development of type 2 diabetes (T2D) and is associated with obesity, physical inactivity, and low maximal oxygen uptake. While intense and prolonged exercise may have negative effects, physical activity can have a positive influence on cellular metabolism and the immune system. Moderate exercise has been shown to reduce oxidative stress and improve antioxidant status, whereas intense exercise can increase oxidative stress in the short term. The impact of exercise on pro-inflammatory cytokine production is complex and varies depending on intensity and duration. Exercise can also counteract the harmful effects of ageing and inflamm-ageing. This review aims to examine the molecular pathways altered by exercise in non-obese individuals at higher risk of developing T2D, including glucose utilization, lipid metabolism, mitochondrial function, inflammation and oxidative stress, with the potential to improve insulin sensitivity. The focus is on understanding the potential benefits of exercise for improving insulin sensitivity and providing insights for future targeted interventions before onset of disease.
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Affiliation(s)
- Shamma Almuraikhy
- Biomedical Research CenterQatar UniversityDohaQatar
- Groningen Research Institute of Pharmacy, Drug DesignGroningen UniversityGroningenThe Netherlands
| | - Asmaa Doudin
- Biomedical Research CenterQatar UniversityDohaQatar
| | - Alexander Domling
- Groningen Research Institute of Pharmacy, Drug DesignGroningen UniversityGroningenThe Netherlands
| | - Asmaa Ali J. F. Althani
- Biomedical Research CenterQatar UniversityDohaQatar
- Department of Biomedical Sciences, College of Health Science, QU HealthQatar UniversityDohaQatar
| | - Mohamed A. Elrayess
- Biomedical Research CenterQatar UniversityDohaQatar
- College of Pharmacy, QU HealthQatar UniversityDohaQatar
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Henn M, Glenn AJ, Willett WC, Martínez-González MA, Sun Q, Hu FB. Changes in Coffee Intake, Added Sugar and Long-Term Weight Gain - Results from Three Large Prospective US Cohort Studies. Am J Clin Nutr 2023; 118:1164-1171. [PMID: 37783371 PMCID: PMC10739774 DOI: 10.1016/j.ajcnut.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Consumption of both caffeinated and decaffeinated coffee has been reported to attenuate long-term weight gain. Whether the association between coffee consumption and weight gain depends on the addition of sugar, cream, or coffee whitener remains unclear. OBJECTIVE We aimed to study the associations between changes in coffee consumption, caffeine intake, and weight changes by considering the addition of sugar, cream, or a nondairy coffee whitener. METHODS We used 3 large prospective cohorts - the Nurses' Health Study (1986 - 2010), Nurses' Health Study II (1991 - 2015) and Health Professional Follow-up Study (1991 - 2014). We applied multivariable linear regression models with robust variance estimators to assess the association of changes in coffee habits within each 4-y interval with concurrent weight changes. Results across the 3 cohorts were pooled using inverse-variance weights. RESULTS After multivariable adjustment, each 1 cup per day increment in unsweetened caffeinated coffee was associated with a reduction in 4-y weight gain of -0.12 kg (95 % CI: -0.18, -0.05 kg) and of -0.12 kg (95 % CI: -0.16, -0.08 kg) for unsweetened decaffeinated coffee. The habits of adding cream or nondairy coffee whitener were not significantly linked to weight changes. Adding a teaspoon of sugar was associated with a 4-y weight gain of +0.09 kg (0.07, 0.12 kg). Stratified analyses suggested stronger magnitude of the observed associations with younger age and higher baseline BMI. Neither caffeine nor coffee modified the association of adding sugar to any food or beverage with weight changes. CONCLUSIONS An increase in intake of unsweetened caffeinated and decaffeinated coffee was inversely associated with weight gain. The addition of sugar to coffee counteracted coffee's benefit for possible weight management. To the contrary, adding cream or coffee whitener was not associated with greater weight gain.
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Affiliation(s)
- Matthias Henn
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; University of Navarra-IdiSNA (Instituto de Investigacion Sanitaria de Navarra), Department of Preventive Medicine and Public Health, Pamplona, Spain
| | - Andrea J Glenn
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Miguel A Martínez-González
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; University of Navarra-IdiSNA (Instituto de Investigacion Sanitaria de Navarra), Department of Preventive Medicine and Public Health, Pamplona, Spain; CIBER Fisiopatología de La Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
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Quan T, Manzi JE, Chen FR, Rauck R, Recarey M, Roszkowska N, Morrison C, Zimmer ZR. Diabetes status and postoperative complications for patients receiving open rotator cuff repair. Shoulder Elbow 2023; 15:25-32. [PMID: 37974606 PMCID: PMC10649476 DOI: 10.1177/17585732211070531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2023]
Abstract
Background Diabetic patients are known to have poor wound healing and worse outcomes following surgeries. The purpose of this study is to evaluate diabetes status and complications for patients receiving open rotator cuff repair. Methods Patients undergoing open rotator cuff repair from 2006 to 2018 were identified in a national database. Patients were stratified into 3 cohorts: no diabetes mellitus, non-insulin dependent diabetes mellitus (NIDDM), and insulin dependent diabetes mellitus (IDDM). Differences in demographics, comorbidities, and complications were assessed with the use of bivariate and multivariate analyses. Results Of 7678 total patients undergoing open rotator cuff repair, 6256 patients (81.5%) had no diabetes, 975 (12.7%) had NIDDM, and 447 (5.8%) had IDDM. Bivariate analyses revealed that IDDM patients had increased risk of mortality, extended length of stay, and readmission compared to non-diabetic patients (p < 0.05 for all). IDDM patients had higher risks of major complications and readmission relative to NIDDM patients (p < 0.05 for both). On multivariate analysis, there were no differences in any postoperative complications between the non-diabetic, NIDDM, and IDDM groups. Discussion Diabetes does not affect postoperative complications following open rotator cuff repairs. Physicians should be aware of this finding and counsel their patients appropriately.Level of Evidence: III.
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Affiliation(s)
- Theodore Quan
- Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
| | | | - Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ryan Rauck
- Sports Medicine, Hospital for Special Surgery, New York, United States
| | - Melina Recarey
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
| | | | | | - Zachary R Zimmer
- Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
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Jeong S, Bonner R, Firari A, Kurti S, Saunders MJ, Womack CJ. The effect of acute hydration on body composition assessed by multi-frequency and single-frequency bioelectrical impedance. J Sports Med Phys Fitness 2023; 63:1069-1074. [PMID: 37335581 DOI: 10.23736/s0022-4707.23.14913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Multi-frequency bioelectrical impedance (MF-BIA) provides an estimate of total body water. However, it is unknown if MF-BIA detects body water increases due to acute hydration, thus affecting the validity of MF-BIA body composition measurements. The purpose of this study was to compare the effects of pre-testing fluid ingestion on body composition estimation using single-frequency bioelectrical impedance (SF-BIA) and MF-BIA. METHODS Thirty-nine subjects (20 male, 19 female) were tested for body composition using DXA, SF-BIA and MF-BIA before and after consumption of 2 L of water. RESULTS Hydration significantly increased fat percentage in men and women for MF-BIA (+2.1±0.7% for men, +2.6±0.7% for women) and SF-BIA (+1.3±0.7% for men, +2.1±0.9% for women). Additionally, hydration significantly increased fat-free mass (FFM) for DXA (+1.4±0.8 kg for men, +1.7±0.4 kg for women) and SF-BIA (+0.5±0.6 kg) in men. Hydration significantly increased fat mass (FM) for all modes (DXA +0.3±0.3 kg, MF-BIA +2.0±0.7 kg, SF-BIA +1.3±0.6 kg) in males, and only for MF-BIA (+2.2±0.3 kg) and SF-BIA (+1.7±0.5 kg) in females. Increases in FM were highest for MF-BIA for both males and females. Total body water was unchanged in males and significantly decreased with acute hydration in females. CONCLUSIONS MF-BIA improperly categorizes increased mass due to acute hydration as fat mass, resulting in an increase in measured body fat percentage. These findings confirm the need to standardize hydration status for body composition measurements using MF-BIA.
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Affiliation(s)
- Soolim Jeong
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, USA
| | - Ryan Bonner
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, USA
| | - Averi Firari
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, USA
| | - Stephanie Kurti
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, USA
| | - Michael J Saunders
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, USA
| | - Christopher J Womack
- Human Performance Laboratory, Department of Kinesiology, James Madison University, Harrisonburg, VA, USA -
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Matias SL, Anderson CE, Koleilat M. Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain. MATERNAL & CHILD NUTRITION 2023; 19:e13545. [PMID: 37357364 PMCID: PMC10483944 DOI: 10.1111/mcn.13545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/08/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023]
Abstract
Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2-4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%-5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.
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Affiliation(s)
- Susana L. Matias
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | | | - Maria Koleilat
- Department of Public HealthCalifornia State UniversityFullertonCaliforniaUSA
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Kurtzhals P, Flindt Kreiner F, Singh Bindra R. The role of weight control in the management of type 2 diabetes mellitus: Perspectives on semaglutide. Diabetes Res Clin Pract 2023; 203:110881. [PMID: 37591343 DOI: 10.1016/j.diabres.2023.110881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used to address multiple aspects of type 2 diabetes mellitus (T2DM) management, including glycaemic control, weight loss, and cardiovascular risk reduction. Semaglutide, a well-established GLP-1 RA approved for T2DM treatment and weight management, demonstrates marked efficacy in achieving these clinically important goals. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus report emphasizes the importance of a holistic approach to T2DM treatment, with weight control as a key component for improving patient outcomes. Notably, semaglutide is mentioned in the consensus report as having 'very high' efficacy for both glucose lowering and weight loss in T2DM treatment. Nevertheless, as has been observed with other weight-lowering drugs, weight loss observed with semaglutide appears less profound in individuals with T2DM than in those with obesity without T2DM, a phenomenon requiring further investigation. The semaglutide safety and tolerability profiles are well established, and it is approved in some countries to reduce cardiovascular risk in certain populations with T2DM. Thus, semaglutide offers a well-established therapeutic option that aligns well with guideline recommendations for T2DM management, emphasizing the high importance of weight control and amelioration of other cardiometabolic risk factors.
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Affiliation(s)
- Peter Kurtzhals
- Novo Nordisk A/S, Vandtaarnsvej 110-114 DK-2860, Søborg, Denmark.
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Bielopolski D, Yemini R, Gravetz A, Yoskovitch O, Keidar A, Carmeli I, Mor E, Rahamimov R, Rozen-Zvi B, Nesher E. Bariatric Surgery in Severely Obese Kidney Donors Before Kidney Transplantation: A Retrospective Study. Transplantation 2023; 107:2018-2027. [PMID: 37291708 DOI: 10.1097/tp.0000000000004645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is the optimal approach for sustained weight loss and may alter donation candidacy in potential donors with obesity. We evaluated the long-term effects of nephrectomy after BS on metabolic profile, including body mass index, serum lipids and diabetes, and kidney function of donors. METHODS This was a single-center retrospective study. Live kidney donors who underwent BS before nephrectomy were matched for age, gender, and body mass index with patients who underwent BS alone and with donors who underwent nephrectomy alone. Estimated glomerular filtration rate (eGFR) was calculated according to Chronic Kidney Disease Epidemiology Collaboration and adjusted to individual body surface area to create absolute eGFR. RESULTS Twenty-three patients who underwent BS before kidney donation were matched to 46 controls who underwent BS alone. At the last follow-up, the study group showed significantly worse lipid profile with low-density lipoprotein of 115 ± 25 mg/dL versus the control group with low-density lipoprotein of 99 ± 29 mg/dL ( P = 0.036) and mean total cholesterol of 191 ± 32 versus 174 ± 33 mg/dL ( P = 0.046). The second control group of matched nonobese kidney donors (n = 72) had similar serum creatinine, eGFR, and absolute eGFR as the study group before nephrectomy and 1 y after the procedure. At the end of follow-up, the study group had significantly higher absolute eGFR compared with the control group (86 ± 21 versus 76 ± 18 mL/min; P = 0.02) and similar serum creatinine and eGFR. CONCLUSIONS BS before live kidney donation is a safe procedure that could increase the donor pool and improve their health in the long run. Donors should be encouraged to maintain their weight and avoid adverse lipid profile and hyperfiltration.
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Affiliation(s)
- Dana Bielopolski
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Renana Yemini
- Department of Surgery, Assuta Medical Center Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviad Gravetz
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Oz Yoskovitch
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Andrei Keidar
- Department of Surgery, Assuta Medical Center Ashdod, Israel
| | - Idan Carmeli
- Department of Surgery, Assuta Medical Center Ashdod, Israel
| | - Eytan Mor
- Department of Surgery B, Transplant Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Eviatar Nesher
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
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Jang H, Kim R, Lee JT, Lee DH, Giovannucci EL, Oh H. Overall and abdominal obesity and risks of all-cause and cause-specific mortality in Korean adults: a pooled analysis of three population-based prospective cohorts. Int J Epidemiol 2023; 52:1060-1073. [PMID: 36622207 DOI: 10.1093/ije/dyac242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Studies found a J-shaped association between body mass index (BMI) and mortality. However, it is unclear whether the association is driven by biases, particularly confounding by fat-free mass. METHODS We conducted an individual-level pooled analysis of three cohorts of Korean adults (aged ≥ 40 years; n = 153 248). Mortality was followed up through December 2019. Anthropometric data were directly measured at baseline. Fat and fat-free mass were predicted using validated prediction models. Using Cox proportional hazards models, we estimated the associations of BMI and waist circumference (WC) with all-cause and cause-specific mortality. To account for biases, we excluded participants aged ≥ 70 years, deaths that occurred within 5 years of follow-up and ever smokers, and adjusted for fat-free mass index (FFMI). RESULTS During the follow-up of up to 18 years, 6061 deaths were identified. We observed J-shaped association of BMI (nadir at 22-26) and monotonically positive association of WC with all-cause, cardiovascular, and cancer mortality among Korean adults without a history of cancer or cardiovascular disease. In the BMI analysis, excluding ever smokers and adjusting for FFMI attenuated the excess mortality in underweight participants and transformed the J-shaped association into a monotonically positive shape, suggesting an increased mortality at BMI > 22.0. Excluding participants aged ≥ 70 years and deaths that occurred within 5 years of follow-up did not change the results. In the WC analysis, the monotonic positive associations did not change after the control. Similar results were observed among participants with a history of cancer or cardiovascular disease. CONCLUSIONS Our data suggest that both overall and abdominal body fat are associated with increased mortality in Korean adults.
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Affiliation(s)
- Hajin Jang
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Dong Hoon Lee
- Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Nutrition, T.H. Chan Harvard School of Public Health, Boston, MA, USA
- Department of Epidemiology, T.H. Chan Harvard School of Public Health, Boston, MA, USA
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Department of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Stroh AM, Stanford KI. Exercise-induced regulation of adipose tissue. Curr Opin Genet Dev 2023; 81:102058. [PMID: 37295241 PMCID: PMC10524364 DOI: 10.1016/j.gde.2023.102058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
Exercise induces various beneficial whole-body adaptations and can delay the onset of obesity, type 2 diabetes, and cardiovascular disease. While many of the beneficial effects of exercise on skeletal muscle and the cardiovascular system have been well established, recent studies have highlighted the role of exercise-induced improvements to adipose tissue that affect metabolic and whole-body health. Studies investigating exercise-induced adaptations of white adipose tissue (WAT) and brown adipose tissue (BAT) demonstrate modifications to glucose uptake, mitochondrial activity, and endocrine profile, and a beiging of WAT in rodents. This review discusses recent studies of the exercise-induced adaptations to WAT and BAT and their implications.
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Affiliation(s)
- Andrew M Stroh
- Dorothy M. Davis Heart and Lung Research Institute, Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. https://twitter.com/@AndrewStroh
| | - Kristin I Stanford
- Dorothy M. Davis Heart and Lung Research Institute, Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Dobbie LJ, Coelho C, Crane J, McGowan B. Clinical evaluation of patients living with obesity. Intern Emerg Med 2023; 18:1273-1285. [PMID: 37119384 PMCID: PMC10412477 DOI: 10.1007/s11739-023-03263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/11/2023] [Indexed: 05/01/2023]
Abstract
Obesity is a significant public health concern which is implicated in cardiometabolic disease, mechanical complications and psychiatric sequelae. BMI is currently used for diagnosis; however, it has limited sensitivity for adiposity in certain circumstances. This has led to the development of risk stratification tools like the Edmonton Staging criteria and the Kings Obesity Staging Criteria: these facilitate and guide comprehensive obesity-related complication assessment. Healthcare professionals working within obesity clinics should adopt evidence-based communication strategies, including shared decision-making, motivational interviewing, and realistic goal setting. It is also vital to avoid weight-stigmatising terminology in all aspects of care, as this can negatively impact patients. Primary care plays an essential part in obesity care and should work to promptly identify cases, initiate treatment and forward on to specialist services where appropriate. Clinical evaluation of the patient living with obesity should take a holistic approach and involve input from bariatric physicians, dietitians, psychologists, and bariatric surgeons, wider members of the multi-disciplinary team should be involved where needed. Clinicians should take a detailed history, examination and order laboratory tests to investigate for complications. Overall, with appropriate evaluation, these assessments can guide patient management and facilitate long-term improvement in health.
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Affiliation(s)
| | | | - James Crane
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Moon JH, Jang Y, Oh TJ, Jung SY. The Risk of Type 2 Diabetes Mellitus according to Changes in Obesity Status in Late Middle-Aged Adults: A Nationwide Cohort Study of Korea. Diabetes Metab J 2023; 47:514-522. [PMID: 37096375 PMCID: PMC10404528 DOI: 10.4093/dmj.2022.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/07/2022] [Indexed: 04/26/2023] Open
Abstract
BACKGRUOUND Although obesity is a well-known risk factor of type 2 diabetes mellitus (T2DM), there is scant data on discriminating the contribution of previous obesity and recent weight gain on developing T2DM. METHODS We analyzed the Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2015 where Korean residents underwent biennial health checkups. Participants were classified into four groups according to their obesity status (body mass index [BMI] ≥25 kg/m2) before and after turning 50 years old: maintaining normal (MN), becoming obese (BO), becoming normal (BN), and maintaining obese (MO). Cox proportional hazards regression model was used to estimate the risk of T2DM factoring in the covariates age, sex, BMI, presence of impaired fasting glucose or hypertension, family history of diabetes, and smoking status. RESULTS A total of 118,438 participants (mean age, 52.5±1.1 years; men, 45.2%) were prospectively evaluated for incident T2DM. A total of 7,339 (6.2%) participants were diagnosed with T2DM during a follow-up period of 4.8±2.6 years. Incidence rates of T2DM per 1,000 person-year were 9.20 in MN, 14.81 in BO, 14.42 in BN, 21.38 in MO. After factoring in covariates, participants in the groups BN (adjusted hazard ratio [aHR], 1.15; 95% confidence interval [CI], 1.04 to 1.27) and MO (aHR, 1.14; 95% CI, 1.06 to 1.24) were at increased risk of developing T2DM compared to MN, whereas BO (hazard ratio, 1.06; 95% CI, 0.96 to 1.17) was not. CONCLUSION Having been obese before 50 years old increased the risk of developing T2DM in the future, but becoming obese after 50 did not. Therefore, it is important to maintain normal weight from early adulthood to prevent future metabolic perturbations.
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Affiliation(s)
- Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeonhoon Jang
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Digital Healthcare, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Se Young Jung
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Digital Healthcare, Seoul National University Bundang Hospital, Seongnam, Korea
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Popoviciu MS, Păduraru L, Yahya G, Metwally K, Cavalu S. Emerging Role of GLP-1 Agonists in Obesity: A Comprehensive Review of Randomised Controlled Trials. Int J Mol Sci 2023; 24:10449. [PMID: 37445623 DOI: 10.3390/ijms241310449] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Obesity is a chronic disease with high prevalence and associated comorbidities, making it a growing global concern. These comorbidities include type 2 diabetes, hypertension, ventilatory dysfunction, arthrosis, venous and lymphatic circulation diseases, depression, and others, which have a negative impact on health and increase morbidity and mortality. GLP-1 agonists, used to treat type 2 diabetes, have been shown to be effective in promoting weight loss in preclinical and clinical studies. This review summarizes numerous studies conducted on the main drugs in the GLP-1 agonists class, outlining the maximum achievable weight loss. Our aim is to emphasize the active role and main outcomes of GLP-1 agonists in promoting weight loss, as well as in improving hyperglycemia, insulin sensitivity, blood pressure, cardio-metabolic, and renal protection. We highlight the pleiotropic effects of these medications, along with their indications, contraindications, and precautions for both diabetic and non-diabetic patients, based on long-term follow-up studies.
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Affiliation(s)
- Mihaela-Simona Popoviciu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410073 Oradea, Romania
| | - Lorena Păduraru
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410073 Oradea, Romania
| | - Galal Yahya
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Al Sharqia 44519, Egypt
- Department of Molecular Genetics, Faculty of Biology, Technical University of Kaiserslautern, Paul-Ehrlich Str. 24, 67663 Kaiserslautern, Germany
| | - Kamel Metwally
- Department of Medicinal Chemistry, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
- Department of Pharmaceutical Medicinal Chemistry, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410073 Oradea, Romania
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Valeri J, Gisabella B, Pantazopoulos H. Dynamic regulation of the extracellular matrix in reward memory processes: a question of time. Front Cell Neurosci 2023; 17:1208974. [PMID: 37396928 PMCID: PMC10311570 DOI: 10.3389/fncel.2023.1208974] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Substance use disorders are a global health problem with increasing prevalence resulting in significant socioeconomic burden and increased mortality. Converging lines of evidence point to a critical role of brain extracellular matrix (ECM) molecules in the pathophysiology of substance use disorders. An increasing number of preclinical studies highlight the ECM as a promising target for development of novel cessation pharmacotherapies. The brain ECM is dynamically regulated during learning and memory processes, thus the time course of ECM alterations in substance use disorders is a critical factor that may impact interpretation of the current studies and development of pharmacological therapies. This review highlights the evidence for the involvement of ECM molecules in reward learning, including drug reward and natural reward such as food, as well as evidence regarding the pathophysiological state of the brain's ECM in substance use disorders and metabolic disorders. We focus on the information regarding time-course and substance specific changes in ECM molecules and how this information can be leveraged for the development of therapeutic strategies.
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Affiliation(s)
- Jake Valeri
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Barbara Gisabella
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Harry Pantazopoulos
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
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Wang N, Li Y, Guo C. Waist-corrected BMI predicts incident diabetes mellitus in a population-based observational cohort study. Front Endocrinol (Lausanne) 2023; 14:1186702. [PMID: 37361520 PMCID: PMC10290140 DOI: 10.3389/fendo.2023.1186702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Waist-corrected body mass index (wBMI), which combines BMI and waist circumference (WC) measurements, has proven superior to either measure alone for predicting obesity but has not yet been applied to the prediction of diabetes mellitus (DM). Methods Over a 5-year period, 305,499 subjects were eligible for this study based on citizen health check-ups in the Tacheng Area of northwest China. Diagnosis of DM was defined as the end point. Results After exclusion, a total of 111,851 subjects were included in the training cohort and 47,906 in the validation cohort. Participants of both sexes with wBMI in the upper quartiles had significantly higher incidence of DM than those with wBMI in the lower quartiles (log-rank χ2 = 236, p< 0.001 for men; log-rank χ2 = 304, p< 0.001 for women). After adjusting for multiple variables, WC, BMI, wBMI, and waist-to-height ratio (WHtR) were all independent predictors for diabetes. In men, the adjusted hazard ratios (HRs) of wBMI for diabetes for the second, third, and fourth quartiles were 1.297 [95% CI: 1.157, 1.455], 1.664 [95% CI: 1.493, 1.853], and 2.132 [95% CI: 1.921, 2.366], respectively, when compared with the first quartile. In women, they were 1.357 [95% CI: 1.191, 1.546], 1.715 [95% CI: 1.517, 1.939], and 2.262 [95% CI: 2.010, 2.545], respectively. Compared with WC, BMI, and WHtR, wBMI had the highest C-index in both men (0.679, 95% CI: 0.670, 0.688) and women (0.730, 95% CI: 0.722, 0.739). Finally, a nomogram was constructed to predict incident DM based on wBMI and other variables. In conclusion, wBMI had the strongest predictive capacity for incident DM when compared with WC, BMI, and WHtR, especially in women. Discussion This study provides a reference for advanced investigation of wBMI on DM and other metabolic diseases in the future.
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Affiliation(s)
- Nana Wang
- Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuying Li
- Health Commission of Tacheng Area, Tacheng, China
| | - Chuanji Guo
- Department of Hospital Administration Office, Shengjing Hospital of China Medical University, Shenyang, China
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Zhao W, Ma X, Ju J, Zhao Y, Wang X, Li S, Sui Y, Sun Q. Association of visceral adiposity index with asymptomatic intracranial arterial stenosis: a population-based study in Shandong, China. Lipids Health Dis 2023; 22:64. [PMID: 37198613 DOI: 10.1186/s12944-023-01831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The visceral adiposity index (VAI), as a composite indictor to evaluate visceral adipose function, has been demonstrated to be correlated with atherosclerosis. The study objective was to explore the association between asymptomatic intracranial arterial stenosis (aICAS) and VAI in Chinese rural dwellers. METHODS The cross-sectional study consisted of 1942 participants ≥ 40 years old who were living in Pingyin County, Shandong Province and free from history of clinical stroke and transient ischemic attack. The aICAS in the study was diagnosed by transcranial doppler ultrasound combined with magnetic resonance angiography. The multivariate logistic regression models were deployed to explore the correlation of VAI with aICAS, and receiver operating characteristic (ROC) curve were plotted to compare the performance of models. RESULTS The participants with aICAS comparing to those without had a significantly higher VAI. After adjusting for confounding factors including age, hypertension, DM, sex, drinking habit, LDL-C, hsCRP, and smoking habit, the VAI-Tertile 3 (vs. VAI-Tertile 1) was positively associated with aICAS (OR, 2.15; 95% CI, 1.25-3.65; P = 0.005). The VAI-Tertile 3 was still markedly associated with aICAS among the underweight and normal weight (BMI ≤ 23.9 kg/m2) participants (OR, 3.17; 95% CI, 1.15-8.71; P = 0.026) with an AUC = 0.684. A similar relationship between VAI and aICAS was obtained among the participants with no abdominal obesity (WHR < 1, OR, 2.03; 95% CI, 1.14-3.62; P = 0.017). CONCLUSIONS The possible correlation between VAI and aICAS was found to be positive for the first time among Chinese rural residents over 40 years old. A higher VAI was found to be significantly associated with aICAS among the participants who were underweight or normal weight, and these results may provide additional risk stratification information for aICAS.
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Affiliation(s)
- Weihua Zhao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xiaotong Ma
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Jiachen Ju
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yuanyuan Zhao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Shan Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yanling Sui
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China.
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Bizhanova Z, Sereika SM, Brooks MM, Rockette-Wagner B, Kariuki JK, Burke LE. Identifying Predictors of Adherence to the Physical Activity Goal: A Secondary Analysis of the SMARTER Weight Loss Trial. Med Sci Sports Exerc 2023; 55:856-864. [PMID: 36574734 PMCID: PMC10106377 DOI: 10.1249/mss.0000000000003114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION/PURPOSE Research is needed to inform tailoring supportive strategies for promoting physical activity (PA) in the context of behavioral treatment of obesity. We aimed to identify baseline participant characteristics and short-term intervention response predictors associated with adherence to the study-defined PA goal in a mobile health (mHealth) weight loss trial. METHODS A secondary analysis was conducted of a 12-month weight loss trial (SMARTER) that randomized 502 adults with overweight or obesity to either self-monitoring of diet, PA, and weight with tailored feedback messages ( n = 251) or self-monitoring alone ( n = 251). The primary outcome was average adherence to the PA goal of ≥150 min·wk -1 of moderate- and vigorous-intensity aerobic activities (MVPA) from Fitbit Charge 2™ trackers over 52 wk. Twenty-five explanatory variables were considered. Machine learning methods and linear regression were used to identify predictors of adherence to the PA goal. RESULTS The sample ( N = 502) was mostly female (80%), White (82%) with the average age of 45 ± 14.4 yr and body mass index of 33.7 ± 4.0 kg·m -2 . Machine learning methods identified PA goal adherence for the first week as the most important predictor of long-term PA goal adherence. In the parsimonious linear regression model, higher PA goal adherence for the first week, greater PA FB messages opened, older age, being male, higher education, being single and not having obstructive sleep apnea were associated with higher long-term PA goal adherence. CONCLUSIONS To our knowledge, this is the first study using machine learning approaches to identify predictors of long-term PA goal adherence in a mHealth weight loss trial. Future studies focusing on facilitators or barriers to PA among young and middle-age adults and women with low PA goal adherence are warranted.
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Affiliation(s)
| | - Susan M. Sereika
- University of Pittsburgh Graduate School of Public Health, PA
- University of Pittsburgh School of Nursing, PA
| | - Maria M. Brooks
- University of Pittsburgh Graduate School of Public Health, PA
| | | | | | - Lora E. Burke
- University of Pittsburgh Graduate School of Public Health, PA
- University of Pittsburgh School of Nursing, PA
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