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Trahair LG, Wu T, Feinle‐Bisset C, Marathe CS, Rayner CK, Horowitz M, Jones KL. Comparative effects of small intestinal glucose on blood pressure, heart rate, and noradrenaline responses in obese and healthy subjects. Physiol Rep 2018; 6:e13610. [PMID: 29446224 PMCID: PMC5812881 DOI: 10.14814/phy2.13610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 02/07/2023] Open
Abstract
Meal consumption leads to an increase in sympathetic output to compensate for hemodynamic changes and maintain blood pressure (BP). Obesity is associated with a blunting of the sympathetic response to meal ingestion, but interpretation of studies investigating these responses is compromised by their failure to account for the rate of gastric emptying, which is an important determinant of postprandial cardiovascular and sympathetic responses and, in both health and obesity, exhibits a wide interindividual variation. We sought to determine the effects of intraduodenal glucose infusion, bypassing gastric emptying, on BP, heart rate (HR), and noradrenaline responses in obese and healthy control subjects. 12 obese subjects (age 36.6 ± 3.9 years, body mass index (BMI) 36.1 ± 1.3 kg/m2 ) and 23 controls (age 27.8 ± 2.4 years, BMI 22.4 ± 0.5 kg/m2 ) received intraduodenal infusions of glucose at 1 or 3 kcal/min, or saline, for 60 min (t = 0-60 min), followed by intraduodenal saline (t = 60-120 min). BP and HR were measured with an automatic cuff, and blood samples collected for measurement of plasma noradrenaline. Intraduodenal glucose at 1 kcal/min was associated with a fall in diastolic BP in the control subjects only (P < 0.01), with no change in systolic BP, HR or noradrenaline in either group. In both groups, intraduodenal glucose at 3 kcal/min was associated with a fall in diastolic (P < 0.01), but not systolic, BP, and rises in HR (P < 0.001) and plasma noradrenaline (P < 0.01), with no difference in responses between the groups. We conclude that cardiovascular and sympathetic responses to intraduodenal glucose infusion are comparable between obese and control subjects, and dependent on the rate of glucose delivery.
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Affiliation(s)
- Laurence G. Trahair
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Tongzhi Wu
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Christine Feinle‐Bisset
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Chinmay S. Marathe
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
| | - Christopher K. Rayner
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Michael Horowitz
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Karen L. Jones
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good HealthAdelaideSouth AustraliaAustralia
- Endocrine and Metabolic UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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102
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Giezenaar C, van der Burgh Y, Lange K, Hatzinikolas S, Hausken T, Jones KL, Horowitz M, Chapman I, Soenen S. Effects of Substitution, and Adding of Carbohydrate and Fat to Whey-Protein on Energy Intake, Appetite, Gastric Emptying, Glucose, Insulin, Ghrelin, CCK and GLP-1 in Healthy Older Men-A Randomized Controlled Trial. Nutrients 2018; 10:nu10020113. [PMID: 29360778 PMCID: PMC5852689 DOI: 10.3390/nu10020113] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 02/07/2023] Open
Abstract
Protein-rich supplements are used widely for the management of malnutrition in the elderly. We reported previously that the suppression of energy intake by whey protein is less in older than younger adults. The aim was to determine the effects of substitution, and adding of carbohydrate and fat to whey protein, on ad libitum energy intake from a buffet meal (180-210 min), gastric emptying (3D-ultrasonography), plasma gut hormone concentrations (0-180 min) and appetite (visual analogue scales), in healthy older men. In a randomized, double-blind order, 13 older men (75 ± 2 years) ingested drinks (~450 mL) containing: (i) 70 g whey protein (280 kcal; 'P280'); (ii) 14 g protein, 28 g carbohydrate, 12.4 g fat (280 kcal; 'M280'); (iii) 70 g protein, 28 g carbohydrate, 12.4 g fat (504 kcal; 'M504'); or (iv) control (~2 kcal). The caloric drinks, compared to a control, did not suppress appetite or energy intake; there was an increase in total energy intake (drink + meal, p < 0.05), which was increased most by the M504-drink. P280- and M504-drink ingestion were associated with slower a gastric-emptying time (n = 9), lower ghrelin, and higher cholecystokinin (CCK) and glucagon-like peptide-1 (GLP-1) than M280 (p < 0.05). Glucose and insulin were increased most by the mixed-macronutrient drinks (p < 0.05). In conclusion, energy intake was not suppressed, compared to a control, and particularly whey protein, affected gastric emptying and gut hormone responses.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Yonta van der Burgh
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Kylie Lange
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Seva Hatzinikolas
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Trygve Hausken
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide, SA 5000, Australia.
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103
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Giezenaar C, Luscombe-Marsh ND, Hutchison AT, Standfield S, Feinle-Bisset C, Horowitz M, Chapman I, Soenen S. Dose-Dependent Effects of Randomized Intraduodenal Whey-Protein Loads on Glucose, Gut Hormone, and Amino Acid Concentrations in Healthy Older and Younger Men. Nutrients 2018; 10:nu10010078. [PMID: 29329233 PMCID: PMC5793306 DOI: 10.3390/nu10010078] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/05/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023] Open
Abstract
Protein-rich supplements are used widely for the prevention and management of malnutrition in older people. We have reported that healthy older, compared to younger, adults have less suppression of energy intake by whey-protein-effects on appetite-related hormones are unknown. The objective was to determine the effects of intraduodenally administered whey-protein on glucose, gut hormone, and amino acid concentrations, and their relation to subsequent ad libitum energy intake at a buffet meal, in healthy older and younger men. Hydrolyzed whey-protein (30 kcal, 90 kcal, and 180 kcal) and a saline control (~0 kcal) were infused intraduodenally for 60 min in 10 younger (19-29 years, 73 ± 2 kg, 22 ± 1 kg/m²) and 10 older (68-81 years, 79 ± 2 kg, 26 ± 1 kg/m²) healthy men in a randomized, double-blind fashion. Plasma insulin, glucagon, gastric inhibitory peptide (GIP), glucagon-like peptide-1 (GLP-1), peptide tyrosine-tyrosine (PYY), and amino acid concentrations, but not blood glucose, increased, while ghrelin decreased during the whey-protein infusions. Plasma GIP concentrations were greater in older than younger men. Energy intake correlated positively with plasma ghrelin and negatively with insulin, glucagon, GIP, GLP-1, PYY, and amino acids concentrations (p < 0.05). In conclusion, intraduodenal whey-protein infusions resulted in increased GIP and comparable ghrelin, insulin, glucagon, GIP, GLP-1, PYY, and amino acid responses in healthy older and younger men, which correlated to subsequent energy intake.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Food and Nutrition, Adelaide 5000, Australia
| | - Amy T Hutchison
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Scott Standfield
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Christine Feinle-Bisset
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, Adelaide 5000, Australia; (C.G.); (N.D.L.-M.); (A.T.H.); (S.S.); (C.F.-B.); (M.H.); (I.C.)
- Correspondence: ; Tel.: +61-8-8313-3638
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104
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Du YT, Kar P, Abdelhamid YA, Horowitz M, Deane AM. Glycated haemoglobin is increased in critically ill patients with stress hyperglycaemia: Implications for risk of diabetes in survivors of critical illness. Diabetes Res Clin Pract 2018; 135:73-75. [PMID: 29133202 DOI: 10.1016/j.diabres.2017.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/02/2017] [Accepted: 10/26/2017] [Indexed: 02/07/2023]
Abstract
It remains uncertain if stress hyperglycaemia (SH) indicates a long-term predisposition to the development of type 2 diabetes. We conducted a retrospective observational study in critically ill patients and found SH to be associated with an increased HbA1c, which may indicate an increased risk of type 2 diabetes.
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Affiliation(s)
- Yang T Du
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5000, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
| | - Palash Kar
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5000, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Yasmine Ali Abdelhamid
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5000, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5000, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
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105
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Giezenaar C, Hutchison AT, Luscombe-Marsh ND, Chapman I, Horowitz M, Soenen S. Effect of Age on Blood Glucose and Plasma Insulin, Glucagon, Ghrelin, CCK, GIP, and GLP-1 Responses to Whey Protein Ingestion. Nutrients 2017; 10:nu10010002. [PMID: 29267221 PMCID: PMC5793230 DOI: 10.3390/nu10010002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/11/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023] Open
Abstract
Protein-rich supplements are used widely to prevent and manage undernutrition in older people. We have previously shown that healthy older, compared to younger, adults have less suppression of energy intake by whey protein-although the effects of age on appetite-related gut hormones are largely unknown. The aim of this study was to determine and compare the acute effects of whey protein loads on blood glucose and plasma gut hormone concentrations in older and younger adults. Sixteen healthy older (eight men, eight women; mean ± SEM: age: 72 ± 1 years; body mass index: 25 ± 1 kg/m²) and 16 younger (eight men, eight women; 24 ± 1 years; 23 ± 0.4 kg/m²) adults were studied on three occasions in which they ingested 30 g (120 kcal) or 70 g (280 kcal) whey protein, or a flavored-water control drink (~2 kcal). At regular intervals over 180 min, blood glucose and plasma insulin, glucagon, ghrelin, cholecystokinin (CCK), gastric inhibitory peptide (GIP), and glucagon-like peptide-1 (GLP-1) concentrations were measured. Plasma ghrelin was dose-dependently suppressed and insulin, glucagon, CCK, GIP, and GLP-1 concentrations were dose-dependently increased by the whey protein ingestion, while blood glucose concentrations were comparable during all study days. The stimulation of plasma CCK and GIP concentrations was greater in older than younger adults. In conclusion, orally ingested whey protein resulted in load-dependent gut hormone responses, which were greater for plasma CCK and GIP in older compared to younger adults.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, 5000 Adelaide, Australia.
| | - Amy T Hutchison
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, 5000 Adelaide, Australia.
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, 5000 Adelaide, Australia.
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Food and Nutrition, 5000 Adelaide, Australia.
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, 5000 Adelaide, Australia.
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, 5000 Adelaide, Australia.
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, 5000 Adelaide, Australia.
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106
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Ali Abdelhamid Y, Plummer MP, Finnis ME, Biradar V, Bihari S, Kar P, Moodie S, Horowitz M, Shaw JE, Phillips LK, Deane AM. Long-term mortality of critically ill patients with diabetes who survive admission to the intensive care unit. CRIT CARE RESUSC 2017; 19:303-309. [PMID: 29202256 DOI: pmid/29202256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Long-term outcomes of critically ill patients with diabetes are unknown. Our objectives were to evaluate the effect of diabetes on both long-term survival rates and the average number of years of life lost for patients admitted to an intensive care unit who survived to hospital discharge. DESIGN AND PARTICIPANTS A data linkage study evaluating all adult patients in South Australia between 2004 and 2011 who survived hospitalisation that required admission to a public hospital ICU. MAIN OUTCOME MEASURES All patients were evaluated using hospital coding for diabetes, which was crossreferenced with registration with the Australian National Diabetes Services Scheme for a diagnosis of diabetes. This dataset was then linked to the Australian National Death Index. Longitudinal survival was assessed using Cox proportional hazards regression. Life-years lost were calculated using age- and sex-specific life-tables from the Australian Bureau of Statistics. RESULTS 5450 patients with diabetes and 17 023 patients without diabetes were included. Crude mortality rates were 105.5 per 1000 person-years (95% CI, 101.6-109.6 per 1000 person-years) for patients with diabetes, and 67.6 per 1000 person-years (95% CI, 65.9-69.3 per 1000 personyears) for patients without diabetes. Patients with diabetes were older and had higher illness severity scores on admission to the ICU, were more likely to die after hospital discharge (unadjusted hazard ratio [HR], 1.52 [95% CI, 1.45-1.59]; adjusted HR, 1.16 [95% CI, 1.10-1.21]; P < 0.0001) and suffered a greater number of average lifeyears lost. CONCLUSIONS Our study indicates that crude mortality for ICU survivors with pre-existing diabetes is considerable after hospital discharge, and the risk of mortality is greater than for survivors without diabetes.
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Affiliation(s)
| | - Mark P Plummer
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Vishwanath Biradar
- Department of Intensive Care Medicine, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Shailesh Bihari
- Department of Critical Care Medicine, Flinders University, Adelaide, SA, Australia
| | - Palash Kar
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stewart Moodie
- Intensive Care Unit, Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Liza K Phillips
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
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107
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Kar P, Jones KL, Plummer MP, Ali Abdelhamid Y, Giersch EJ, Summers MJ, Hatzinikolas S, Heller S, Horowitz M, Deane AM. Antecedent Hypoglycemia Does Not Attenuate the Acceleration of Gastric Emptying by Hypoglycemia. J Clin Endocrinol Metab 2017; 102:3953-3960. [PMID: 28973430 PMCID: PMC5673277 DOI: 10.1210/jc.2017-00051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/21/2017] [Indexed: 02/07/2023]
Abstract
Context Acute hypoglycemia accelerates gastric emptying and increases cardiac contractility. However, antecedent hypoglycemia attenuates counterregulatory hormonal responses to subsequent hypoglycemia. Objective To determine the effect of antecedent hypoglycemia on gastric and cardiac responses to subsequent hypoglycemia in health. Design A prospective, single-blind, randomized, crossover study (performed at the Royal Adelaide Hospital, Adelaide, South Australia, Australia). Patients Ten healthy young men 18 to 35 years of age were studied for 36 hours on two occasions. Interventions Participants were randomly assigned to either antecedent hypoglycemia [three 45-minute periods of strict hypoglycemia (2.8 mmol/L] or control [three 45-minute periods of strict euglycemia (6 mmol/L)] during the initial 12-hour period. Participants were monitored overnight, and the following morning blood glucose was clamped at 2.8 mmol/L for 60 minutes and then at 6 mmol/L for 120 minutes. At least 6 weeks later participants returned for the alternative intervention. Gastric emptying and cardiac fractional shortening were measured with scintigraphy and two-dimensional echocardiography, respectively, on the morning of all 4 study days. Results A single, acute episode of hypoglycemia accelerated gastric emptying (P = 0.01) and augmented fractional shortening (P < 0.01). Gastric emptying was unaffected by antecedent hypoglycemia (P = 0.74) whereas fractional shortening showed a trend to attenuation (P = 0.06). The adrenaline response was diminished (P < 0.05) by antecedent hypoglycemia. Conclusions In health, the acceleration of gastric emptying during hypoglycemia is unaffected by antecedent hypoglycemia, whereas the increase in cardiac contractility may be attenuated.
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Affiliation(s)
- Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Karen L. Jones
- National Health and Medical Research Council Centre of Research Excellence in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, South Australia 5005, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Mark P. Plummer
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Yasmine Ali Abdelhamid
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Emma J. Giersch
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Matthew J. Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Seva Hatzinikolas
- National Health and Medical Research Council Centre of Research Excellence in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield S10 2TN, United Kingdom
| | - Michael Horowitz
- National Health and Medical Research Council Centre of Research Excellence in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, South Australia 5005, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Adam M. Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia
- Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
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108
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Steinert RE, Ullrich SS, Geary N, Asarian L, Bueter M, Horowitz M, Feinle-Bisset C. Comparative effects of intraduodenal amino acid infusions on food intake and gut hormone release in healthy males. Physiol Rep 2017; 5:e13492. [PMID: 29138359 PMCID: PMC5688783 DOI: 10.14814/phy2.13492] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023] Open
Abstract
In contrast to the many studies of the effects of individual amino acids (AAs) on eating, no studies have compared the effects of different AAs on eating and underlying preabsorptive gastrointestinal mechanisms. To compare the effects of intraduodenal infusions of l-tryptophan (TRP), l-leucine (LEU), l-phenylalanine (PHE) and l-glutamine (GLN) on appetite, gastrointestinal hormone responses (including ghrelin, cholecystokinin (CCK), peptide YY (PYY) and glucagon-like peptide-1 [GLP-1]), glycemia (glucagon, insulin and glucose) and test meal size in healthy males, we retrospectively analyzed data from four published independent, randomized, double-blind, placebo-controlled studies of 90-min intraduodenal infusions of the individual AAs. The designs of the studies were identical, except the dose of TRP (0.15 kcal/min) was lower than that of the other AAs (0.45 kcal/min) because higher doses of this AA were not well tolerated. TRP and LEU decreased intake more than PHE (reductions relative to control, ~219 ± 68, ~170 ± 48 and ~12 ± 57 kcal, respectively), and TRP decreased intake more than GLN (~31 ± 82 kcal). These effects of TRP and LEU versus GLN, but not versus PHE, were paralleled by greater decreases in plasma ghrelin, and increases in CCK, concentrations. TRP increased PYY more than GLN or LEU, but not PHE. LEU increased PYY less than PHE. No significant differences were detected for GLP-1. PHE increased glucagon more than TRP or LEU, and increased insulin more than TRP. Under our experimental conditions, intraduodenal TRP and LEU were more satiating than PHE and GLN. The greater satiating efficacy of LEU versus PHE was significantly dissociated from the effects of these AAs on PYY, while the greater satiating potency of TRP versus PHE was significantly dissociated from the effects of these AAs on insulin and glucagon. In contrast, ghrelin and CCK, and potentially other mechanisms, including central sensing of individual AAs, appear to be stronger candidate mechanisms for the relative satiating effects obtained.
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Affiliation(s)
- Robert E Steinert
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Sina S Ullrich
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, South Australia, Australia
| | - Nori Geary
- Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Lori Asarian
- Department of Medicine-Immunobiology, Robert Larner College of Medicine University of Vermont, Burlington, Vermont
| | - Marco Bueter
- Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, South Australia, Australia
| | - Christine Feinle-Bisset
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, South Australia, Australia
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Marathe CS, Rayner CK, Jones KL, Horowitz M. Gastrointestinal motility in people with type 1 diabetes and peripheral neuropathy. Diabetologia 2017; 60:2312-2313. [PMID: 28801705 DOI: 10.1007/s00125-017-4391-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Level 6, Eleanor Harrald Building, Adelaide, SA, 5000, Australia.
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia.
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Level 6, Eleanor Harrald Building, Adelaide, SA, 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Level 6, Eleanor Harrald Building, Adelaide, SA, 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Level 6, Eleanor Harrald Building, Adelaide, SA, 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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110
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Giezenaar C, Coudert Z, Baqeri A, Jensen C, Hausken T, Horowitz M, Chapman I, Soenen S. Effects of Timing of Whey Protein Intake on Appetite and Energy Intake in Healthy Older Men. J Am Med Dir Assoc 2017; 18:898.e9-898.e13. [PMID: 28804009 DOI: 10.1016/j.jamda.2017.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/26/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Protein-rich supplements are used widely to prevent and manage malnutrition in older adults. We previously showed that 30 g whey protein ingestion, 3 hours before a buffet meal, suppressed energy intake in young, but not in older men. Information about the impact of the timing of ingestion of protein drinks on the suppression of energy intake in older adults is lacking. OBJECTIVE The aim of the study was to determine the effect of the timing of whey protein ingestion on appetite and subsequent ad libitum energy intake in healthy older men. DESIGN In a single blind, randomized design, 16 older men were studied on 5 occasions, on which they consumed a whey protein drink (30 g/120 kcal, 140 mL) 3, 2, 1 hour(s), or immediately before a buffet meal, from which ad libitum energy intake was quantified, and isopalatable noncaloric drinks (∼1 kcal) at the remaining time points. On the control day, noncaloric drinks were ingested at all time points. Perceptions of appetite and gastrointestinal symptoms were determined, by visual analog scales, throughout the study days. RESULTS There was no effect of the timing of protein ingestion on perceptions of appetite and gastrointestinal symptoms (P > .05) or energy intake at the buffet meal (3 hours: 888 ± 49 kcal, 2 hours: 879 ± 56 kcal, 1 hours: 909 ± 47 kcal, 0 hour: 892 ± 51 kcal, control: 930 ± 49 kcal, P = .94). Total energy intake (ie, preload + test meal) was higher on the protein days compared with control (82 ± 24 kcal increase, P = .003). CONCLUSIONS In older men, ingestion of 30 g protein increased total energy intake, irrespective of the time of intake in relation to the meal. These observations support the use of "pure" whey protein drinks to increase overall protein and energy intake in older adults at risk of undernutrition.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Zoé Coudert
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Abdul Baqeri
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Caroline Jensen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Section for Neuroendocrine Gastroenterology, Division of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trygve Hausken
- Section for Neuroendocrine Gastroenterology, Division of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia (NHMRC) Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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111
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Wu T, Rayner CK, Watson LE, Jones KL, Horowitz M, Little TJ. Comparative effects of intraduodenal fat and glucose on the gut-incretin axis in healthy males. Peptides 2017; 95:124-127. [PMID: 28800948 DOI: 10.1016/j.peptides.2017.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/24/2017] [Accepted: 08/02/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The interaction of nutrients with the small intestine stimulates the secretion of numerous enteroendocrine hormones that regulate postprandial metabolism. However, differences in gastrointestinal hormonal responses between the macronutrients are incompletely understood. In the present study, we compared blood glucose and plasma hormone concentrations in response to standardised intraduodenal (ID) fat and glucose infusions in healthy humans. METHODS In a parallel study design, 16 healthy males who received an intraduodenal fat infusion were compared with 12 healthy males who received intraduodenal glucose, both at a rate of 2kcal/min over 120min. Venous blood was sampled at frequent intervals for measurements of blood glucose, and plasma total and active glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), insulin and glucagon. RESULTS Plasma concentrations of the incretin hormones (both total and active GLP-1 and GIP) and glucagon were higher, and plasma insulin and blood glucose concentrations lower, during intraduodenal fat, when compared with intraduodenal glucose, infusion (treatment by time interaction: P<0.001 for each). CONCLUSIONS Compared with glucose, intraduodenal fat elicits substantially greater GLP-1, GIP and glucagon secretion, with minimal effects on blood glucose or plasma insulin in healthy humans. These observations are consistent with the concept that fat is a more potent stimulus of the 'gut-incretin' axis than carbohydrate.
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Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
| | - Christopher K Rayner
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Linda E Watson
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tanya J Little
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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112
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Giezenaar C, Trahair LG, Luscombe-Marsh ND, Hausken T, Standfield S, Jones KL, Lange K, Horowitz M, Chapman I, Soenen S. Effects of randomized whey-protein loads on energy intake, appetite, gastric emptying, and plasma gut-hormone concentrations in older men and women. Am J Clin Nutr 2017; 106:865-877. [PMID: 28747330 DOI: 10.3945/ajcn.117.154377] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Protein- and energy-rich supplements are used widely for the management of malnutrition in the elderly. Information about the effects of protein on energy intake and related gastrointestinal mechanisms and whether these differ between men and women is limited.Objective: We determined the effects of whey protein on energy intake, appetite, gastric emptying, and gut hormones in healthy older men and women.Design: Eight older women and 8 older men [mean ± SEM age: 72 ± 1 y; body mass index (in kg/m2): 25 ± 1] were studied on 3 occasions in which they received protein loads of 30 g (120 kcal) or 70 g (280 kcal) or a flavored water control drink (0 kcal). At regular intervals over 180 min, appetite (visual analog scales), gastric emptying (3-dimensional ultrasonography), and blood glucose and plasma gut-hormone concentrations [insulin, glucagon, ghrelin, cholecystokinin, gastric inhibitory polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and peptide tyrosine tyrosine (PYY)] were measured, and ad libitum energy intake was quantified from a buffet meal (180-210 min; energy intake, appetite, and gastric emptying in the men have been published previously).Results: Energy intake at the buffet meal was ∼80% higher in older men than in older women (P < 0.001). Energy intake was not suppressed by protein compared with the control in men or women (P > 0.05). There was no effect of sex on gastric emptying, appetite, gastrointestinal symptoms, glucose, or gut hormones (P > 0.05). There was a protein load-dependent slowing of gastric emptying, an increase in concentrations of insulin, glucagon, cholecystokinin, GIP, GLP-1, and PYY, and an increase in total energy intake (drink plus meal: 12% increase with 30 g and 32% increase with 70 g; P < 0.001). Energy intake at the buffet meal was inversely related to the stomach volume and area under the curve of hormone concentrations (P < 0.05).Conclusion: In older men and women, whey-protein drinks load-dependently slow gastric emptying and alter gut hormone secretion compared with a control but have no suppressive effect on subsequent ad libitum energy intake. This trial was registered at www.anzctr.org.au as ACTRN12612000941864.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Laurence G Trahair
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Natalie D Luscombe-Marsh
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- The Commonwealth Scientific and Industrial Research Organisation, Animal, Food and Health Sciences, Adelaide, South Australia, Australia; and
| | - Trygve Hausken
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Scott Standfield
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen L Jones
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Chapman
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stijn Soenen
- Discipline of Medicine and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia;
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113
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Bonadonna RC, Blonde L, Antsiferov M, Berria R, Gourdy P, Hatunic M, Mohan V, Horowitz M. Lixisenatide as add-on treatment among patients with different β-cell function levels as assessed by HOMA-β index. Diabetes Metab Res Rev 2017; 33:e2897. [PMID: 28303626 PMCID: PMC5600123 DOI: 10.1002/dmrr.2897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 02/22/2017] [Accepted: 02/26/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effect of lixisenatide-a prandial once-daily glucagon-like peptide-1 receptor agonist-on glycaemic control in patients with inadequately controlled type 2 diabetes mellitus (T2DM), stratified by baseline β-cell function, was assessed. METHODS The 24-week GetGoal-M, -P and -S trials evaluated the efficacy and safety of lixisenatide in combination with oral antidiabetic agents. This post hoc analysis used data from patients receiving lixisenatide in these trials, divided into matched cohorts by propensity scoring, and stratified according to baseline homeostasis model assessment of β-cell function (HOMA-β) index levels, high HOMA-β: > median HOMA-β (28.49%); low HOMA-β: ≤ median. RESULTS The matched "low" and "high" HOMA-β index cohorts (N = 546 patients) had comparable baseline parameters. Mean change from baseline in glycated haemoglobin (HbA1c ) was -0.85% and -0.94% for low and high HOMA-β cohorts, respectively (P = .2607). Reductions from baseline in fasting plasma glucose (FPG; -0.77 vs -1.04 mmol/L; P = .1496) and postprandial plasma glucose (PPG; -5.82 vs -5.61 mmol/L; P = .7511) were similar in the low versus high HOMA-β index cohorts. Reduction in body weight was significantly greater in the low versus high HOMA-β index cohort (-2.06 vs -1.13 kg, respectively; P = .0006). CONCLUSIONS In patients with T2DM, lixisenatide was associated with reduction in HbA1c and improvements in both FPG and PPG, regardless of β-cell function, indicating that lixisenatide is effective in reducing hyperglycaemia, even in patients with more advanced stages of T2DM and poor residual β-cell function.
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Affiliation(s)
| | - Lawrence Blonde
- Frank Riddick Diabetes InstituteDepartment of Endocrinology, Ochsner Medical CenterNew OrleansLAUSA
| | | | | | - Pierre Gourdy
- Diabetology DepartmentToulouse University HospitalToulouseFrance
| | - Mensud Hatunic
- Department of EndocrinologyMater Misericordiae University HospitalDublinIreland
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities CentreChennaiIndia
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114
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Trahair LG, Rajendran S, Visvanathan R, Chapman M, Stadler D, Horowitz M, Jones KL. Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension. Physiol Rep 2017; 5:5/13/e13341. [PMID: 28684639 PMCID: PMC5506527 DOI: 10.14814/phy2.13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023] Open
Abstract
Postprandial hypotension (PPH) occurs frequently and is thought to reflect an inadequate increase in cardiac output to compensate for the rise in splanchnic blood flow after a meal. Gastric distension by water attenuates the postprandial fall in blood pressure (BP). Cardiac hemodynamics (stroke volume (SV), cardiac output (CO), and global longitudinal strain (GLS)) have hitherto not been measured in PPH We sought to determine the comparative effects of water and glucose drinks on cardiac hemodynamics in healthy older subjects and individuals with PPH Eight healthy older subjects (age 71.0 ± 1.7 years) and eight subjects with PPH (age 75.5 ± 1.0 years) consumed a 300 mL drink of either water or 75 g glucose (including 150 mg 13C-acetate) in randomized order. BP and heart rate (HR) were measured using an automatic device, SV, CO, and GLS by transthoracic echocardiography and gastric emptying by measurement of 13CO2 In both groups, glucose decreased systolic BP (P < 0.001) and increased HR, SV, and CO (P < 0.05 for all). The fall in systolic BP was greater (P < 0.05), and increase in HR less (P < 0.05), in the PPH group, with no difference in SV or CO Water increased systolic BP (P < 0.05) in subjects with PPH and, in both groups, decreased HR (P < 0.05) without affecting SV, CO, or GLS In subjects with PPH, the hypotensive response to glucose and the pressor response to water were related (R = -0.75, P < 0.05). These observations indicate that, in PPH, the hypotensive response to oral glucose is associated with inadequate compensatory increases in CO and HR, whereas the pressor response to water ingestion is maintained and, possibly, exaggerated.
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Affiliation(s)
- Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
| | - Sharmalar Rajendran
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology Unit, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
- Cardiology Unit, Lyell McEwin Hospital Northern Local Health Network, Elizabeth Vale, South Australia, Australia
| | - Renuka Visvanathan
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre School of Medicine The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew Chapman
- Cardiology Unit, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Daniel Stadler
- Cardiology Unit, The Queen Elizabeth Hospital Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health The University of Adelaide, Adelaide, South Australia, Australia
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115
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Ullrich SS, Fitzgerald PC, Nkamba I, Steinert RE, Horowitz M, Feinle-Bisset C. Intragastric Lysine Lowers the Circulating Glucose and Insulin Responses to a Mixed-Nutrient Drink without Slowing Gastric Emptying in Healthy Adults. J Nutr 2017; 147:1275-1281. [PMID: 28592515 DOI: 10.3945/jn.117.252213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/28/2017] [Accepted: 05/11/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Lysine is reported to lower the glycemic response to oral glucose in humans and, albeit at high loads, to slow gastric emptying of glucose and decrease food intake in rats.Objective: We investigated the effects of intragastrically administered lysine on early (15 min) and later (60 min) blood glucose and insulin responses to and gastric emptying of a mixed-nutrient drink, and effects on subsequent energy intake.Methods: Twelve healthy volunteers (7 men and 5 women; mean ± SEM age: 24 ± 2 y) received intragastric infusions (200 mL) containing 5 or 10 g l-lysine or a control solution within 2 min on 3 different occasions in randomized order. Fifteen minutes later, participants consumed a mixed-nutrient drink (300 mL, 400 kcal, and 56 g carbohydrates) within 1 min. For the next hour (t = 0-60 min), we collected blood samples every 15 min (to measure blood glucose, plasma insulin, and plasma glucagon) and breath samples every 5 min (to measure gastric emptying via a 13C-acetate breath test). We then quantified subjects' energy intake from a buffet-style meal (t = 60-90 min).Results: There were no differences between the 2 lysine treatments; hence, data were pooled for further analysis. Lysine did not affect blood glucose at 15 min or the blood glucose area under the curve from 0 to 60 min (AUC0-60min) but it decreased blood glucose at 60 min compared with the control solution (-9.1% ± 3.1%, P < 0.01). Similarly, the early insulin response and insulin AUC0-60min were not affected by lysine, but plasma insulin at 60 min was 20.9% ± 5.6% lower than after the control (P < 0.05). Plasma glucagon at both 15 min (20.7% ± 4.7%, P < 0.001) and 60 min (14.1% ± 5.4%, P < 0.05) and the glucagon AUC0-60min (P < 0.01) were greater after lysine than after the control. Lysine did not slow gastric emptying, and there was no effect on energy intake.Conclusion: In healthy adults, lysine slightly reduced the glycemic response to an oral mixed-macronutrient drink, an effect that was apparently independent of insulin or slowing of gastric emptying. This trial was registered at www.anzctr.orgau as 12614000837628.
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Affiliation(s)
- Sina S Ullrich
- University of Adelaide Discipline of Medicine, Adelaide, Australia; and
- National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Penelope Ce Fitzgerald
- University of Adelaide Discipline of Medicine, Adelaide, Australia; and
- National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Iris Nkamba
- University of Adelaide Discipline of Medicine, Adelaide, Australia; and
| | - Robert E Steinert
- University of Adelaide Discipline of Medicine, Adelaide, Australia; and
- National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Michael Horowitz
- University of Adelaide Discipline of Medicine, Adelaide, Australia; and
- National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Christine Feinle-Bisset
- University of Adelaide Discipline of Medicine, Adelaide, Australia; and
- National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
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Horowitz M, Aroda VR, Han J, Hardy E, Rayner CK. Upper and/or lower gastrointestinal adverse events with glucagon-like peptide-1 receptor agonists: Incidence and consequences. Diabetes Obes Metab 2017; 19:672-681. [PMID: 28058769 PMCID: PMC5412849 DOI: 10.1111/dom.12872] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/16/2016] [Accepted: 12/29/2016] [Indexed: 02/05/2023]
Abstract
AIMS To characterize gastrointestinal adverse events (AEs) with different glucagon-like peptide-1 receptor agonists (GLP-1RAs). METHODS Two retrospective intention-to-treat analyses of 6-month patient-level data were conducted. Data from three studies comparing exenatide once weekly (n = 617) with exenatide twice daily (n = 606) were pooled, and one (DURATION-6) comparing exenatide once weekly (n = 461) with liraglutide (n = 450) was analysed separately. Patient-reported gastrointestinal AEs were classified as upper or lower, AE incidences and timing were determined, subgroups were analysed, and associations of gastrointestinal AEs with efficacy were examined. RESULTS Nausea was the most common gastrointestinal AE for all treatments. Fewer exenatide once-weekly-treated vs exenatide twice-daily- or liraglutide-treated patients reported gastrointestinal AEs (34% vs 45% and 25% vs 41%, respectively; both P < .0001). Fewer exenatide once-weekly-treated patients reported upper plus lower events than liraglutide-treated patients ( P < .001); the difference between exenatide once weekly and twice daily was not significant. Within each group, more women than men reported gastrointestinal AEs. Events occurrred early and were predominantly mild. Glycated haemoglobin reductions were similar for patients with or without gastrointestinal AEs. Weight loss was greater for patients with gastrointestinal AEs with exenatide once weekly and exenatide twice daily ( P < .05); no difference was observed in DURATION-6. CONCLUSIONS Gastrointestinal AEs were less frequent with exenatide once weekly vs exenatide twice daily or liraglutide, and combined upper and lower events occurred less often. Gastrointestinal AEs were typically mild and occurred early. Gastrointestinal AEs did not affect glycaemic control but may be associated with greater weight loss.
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Affiliation(s)
- Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of AdelaideAdelaideSouth AustraliaAustralia
| | - Vanita R. Aroda
- Community Clinical Research Center, MedStar Health Research InstituteHyattsvilleMaryland
| | | | - Elise Hardy
- Clinical Research, AstraZenecaGaithersburgMaryland
| | - Chris K. Rayner
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of AdelaideAdelaideSouth AustraliaAustralia
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117
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Wu T, Trahair LG, Little TJ, Bound MJ, Zhang X, Wu H, Sun Z, Horowitz M, Rayner CK, Jones KL. Effects of Vildagliptin and Metformin on Blood Pressure and Heart Rate Responses to Small Intestinal Glucose in Type 2 Diabetes. Diabetes Care 2017; 40:702-705. [PMID: 28258090 DOI: 10.2337/dc16-2391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/16/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate effects of vildagliptin and metformin on blood pressure (BP) and heart rate (HR) responses to intraduodenal (ID) glucose in diet-controlled type 2 diabetes. RESEARCH DESIGN AND METHODS Study A compared vildagliptin (50 mg) and placebo, given 60 min before a 120-min ID glucose infusion at 2 or 4 kcal/min (ID2 or ID4) in 16 patients. Study B compared metformin (850 mg) and placebo, given 30 min before ID2 over 120 min in 9 patients. RESULTS Systolic (P = 0.002) and diastolic (P < 0.001) BP were lower and HR greater (P = 0.005) after vildagliptin compared with placebo, without interaction between vildagliptin and the glucose infusion rate. In contrast, HR was greater after metformin than placebo (P < 0.001), without any difference in systolic or diastolic BP. CONCLUSIONS Vildagliptin reduces BP and increases HR, whereas metformin increases HR without affecting BP during ID glucose infusion in type 2 diabetes. These distinct cardiovascular profiles during enteral nutrient exposure may have implications for postprandial hypotension.
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Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tanya J Little
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michelle J Bound
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Xiang Zhang
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hang Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Malbert CH, Picq C, Divoux JL, Henry C, Horowitz M. Obesity-Associated Alterations in Glucose Metabolism Are Reversed by Chronic Bilateral Stimulation of the Abdominal Vagus Nerve. Diabetes 2017; 66:848-857. [PMID: 28082456 DOI: 10.2337/db16-0847] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/09/2017] [Indexed: 02/05/2023]
Abstract
Acute vagal stimulation modifies glucose and insulin metabolism, but the effect of chronic bilateral vagal stimulation is not known. Our aim was to quantify the changes in whole-body and organ-specific insulin sensitivities 12 weeks after permanent, bilateral, vagal stimulation performed at the abdominal level in adult mini-pigs. In 15 adult mini-pigs, stimulating electrodes were placed around the dorsal and ventral vagi using laparoscopy and connected to a dual-channel stimulator placed subcutaneously. Animals were divided into three groups based on stimulation and body weight (i.e., lean nonstimulated, obese nonstimulated, and obese stimulated). Twelve weeks after surgery, glucose uptake and insulin sensitivity were measured using positron emission tomography during an isoglycemic clamp. Mean whole-body insulin sensitivity was lower by 34% (P < 0.01) and the hepatic glucose uptake rate was lower by 33% (P < 0.01) in obese-nonstimulated mini-pigs but was no different in obese-stimulated compared with lean mini-pigs. An improvement in skeletal glucose uptake rate was also observed in obese-stimulated compared with obese-nonstimulated groups (P < 0.01). Vagal stimulation was associated with increased glucose metabolism in the cingulate and prefrontal brain areas. We conclude that chronic vagal stimulation improves insulin sensitivity substantially in diet-induced obesity by both peripheral and central mechanisms.
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Affiliation(s)
- Charles-Henri Malbert
- Ani-Scans, Department of Nutrition, French National Institute for Agricultural Research, Saint-Gilles, France
| | | | | | | | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
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Rayner CK, Jones KL, Wu T, Horowitz M. Gut feelings about diabetes and GLP-1 receptor agonists: lessons to be learnt from studies in functional gastrointestinal disorders. Diabetes Obes Metab 2017; 19:309-312. [PMID: 27862814 DOI: 10.1111/dom.12822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Christopher K Rayner
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Tongzhi Wu
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
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Miller A, Deane AM, Plummer MP, Cousins CE, Chapple LAS, Horowitz M, Chapman MJ. Exogenous glucagon-like peptide-1 attenuates glucose absorption and reduces blood glucose concentration after small intestinal glucose delivery in critical illness. CRIT CARE RESUSC 2017; 19:37-42. [PMID: 28215130 DOI: pmid/28215130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effect of exogenous glucagonlike peptide-1 (GLP-1) on small intestinal glucose absorption and blood glucose concentrations during critical illness. DESIGN, SETTING AND PARTICIPANTS A prospective, blinded, placebo-controlled, cross-over, randomised trial in a mixed medical-surgical adult intensive care unit, with 12 mechanically ventilated critically ill patients, who were suitable for receiving small intestinal nutrient. INTERVENTIONS On consecutive days, in a randomised order, participants received intravenous GLP-1 (1.2 pmol/ kg/min) or placebo (0.9% saline) as a continuous infusion over 270 minutes. After 6 hours of fasting, intravenous infusions of GLP-1 or placebo began at T = -30 min (in which T = time), with the infusion maintained at a constant rate until study completion at T = 240 min. At T = 0 min, a 100 mL bolus of mixed liquid nutrient meal (1 kcal/mL) containing 3 g of 3-O-methyl-D-gluco-pyranose (3-OMG), a marker of glucose absorption, was administered directly into the small intestine, via a post-pyloric catheter, over 6 minutes. MAIN OUTCOME MEASURES Blood samples were taken at regular intervals for the measurement of plasma glucose and 3-OMG concentrations. RESULTS Intravenous GLP-1 attenuated initial small intestinal glucose absorption (mean area under the curve [AUC]0-30 for 3-OMG: GLP-1 group, 4.4 mmol/L/min [SEM, 0.9 mmol/L/min] v placebo group, 6.5 mmol/L/min [SEM, 1.0 mmol/L/min]; P = 0.01), overall small intestinal glucose absorption (mean AUC0-240 for 3-OMG: GLP-1, 68.2 mmol/L/ min [SEM, 4.7 mmol/L/min] v placebo, 77.7 mmol/L/min [SEM, 4.4 mmol/lLmin]; P = 0.02), small intestinal glucose absorption and overall blood glucose concentration (mean AUC0-240 for blood glucose: GLP-1, 2062 mmol/L/min [SEM, 111 mmol/L/min] v placebo 2328 mmol/L/min [SEM, 145 mmol/L/min]; P = 0.005). CONCLUSIONS Short-term administration of exogenous GLP-1 reduces small intestinal glucose absorption for up to 4 hours during critical illness. This is likely to be an additional mechanism for the glucose-lowering effect of this agent.
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Affiliation(s)
| | - Adam M Deane
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Mark P Plummer
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | | | | | - Michael Horowitz
- NHMRC Centre of Research Excellence in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, SA, Australia
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Marathe CS, Rayner CK, Lange K, Bound M, Wishart J, Jones KL, Kahn SE, Horowitz M. Relationships of the early insulin secretory response and oral disposition index with gastric emptying in subjects with normal glucose tolerance. Physiol Rep 2017; 5:5/4/e13122. [PMID: 28242817 PMCID: PMC5328768 DOI: 10.14814/phy2.13122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023] Open
Abstract
The oral disposition index, the product of the early insulin secretory response during an oral glucose tolerance test and insulin sensitivity, is used widely for both the prediction of, and evaluation of the response to interventions, in type 2 diabetes. Gastric emptying, which determines small intestinal exposure of nutrients, modulates postprandial glycemia. The aim of this study was to determine whether the insulin secretory response and the disposition index (DI) related to gastric emptying in subjects with normal glucose tolerance. Thirty-nine subjects consumed a 350 mL drink containing 75 g glucose labeled with 99mTc-sulfur colloid. Gastric emptying (by scintigraphy), blood glucose (G) and plasma insulin (I) were measured between t = 0-120 min. The rate of gastric emptying was derived from the time taken for 50% emptying (T50) and expressed as kcal/min. The early insulin secretory response was estimated by the ratio of the change in insulin (∆I0-30) to that of glucose at 30 min (∆G0-30) represented as ∆I0-30/∆G0-30 Insulin sensitivity was estimated as 1/fasting insulin and the DI was then calculated as ∆I0-30/∆G0-30 × 1/fasting insulin. There was a direct relationship between ∆G0-30 and gastric emptying (r = 0.47, P = 0.003). While there was no association of either ∆I0-30 (r = -0.16, P = 0.34) or fasting insulin (r = 0.21, P = 0.20), there were inverse relationships between the early insulin secretory response (r = -0.45, P = 0.004) and the DI (r = -0.33, P = 0.041), with gastric emptying. We conclude that gastric emptying is associated with both insulin secretion and the disposition index in subjects with normal glucose tolerance, such that when gastric emptying is relatively more rapid, both the early insulin secretory response and the disposition index are less. These findings should be interpreted as "hypothesis generating" and provide the rationale for longitudinal studies to examine the impact of baseline rate of gastric emptying on the prospective risk of type 2 diabetes.
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Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine, University of Adelaide Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, University of Adelaide Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Kylie Lange
- Discipline of Medicine, University of Adelaide Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Michelle Bound
- Discipline of Medicine, University of Adelaide Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Judith Wishart
- Discipline of Medicine, University of Adelaide Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, University of Adelaide Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Steven E Kahn
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide Royal Adelaide Hospital, Adelaide, Australia
- Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
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Trahair LG, Marathe CS, Standfield S, Rayner CK, Feinle-Bisset C, Horowitz M, Jones KL. Effects of small intestinal glucose on glycaemia, insulinaemia and incretin hormone release are load-dependent in obese subjects. Int J Obes (Lond) 2017; 41:225-232. [PMID: 27840416 DOI: 10.1038/ijo.2016.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/10/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Studies concerning the glycaemic response to oral glucose, or meals in obesity have usually failed to account for gastric emptying. It has been suggested that the incretin effect may be diminished in obesity as a result of a reduction in glucagon-like peptide-1 (GLP-1) secretion. We sought to determine the effect of two different rates of intraduodenal glucose infusions on glycaemic, insulinaemic and incretin hormone responses in lean and obese subjects and compare the effects of oral and intraduodenal glucose in obese subjects. SUBJECTS/METHODS Eleven obese subjects (age 37.5±4.1 years, body mass index (BMI) 35.7±1.4 kg m-2) and 12 controls (age 34.7±4.0 years, BMI 23.9±0.7 kg m-2) received intraduodenal infusions of glucose at 1 or 3 kcal min-1, or saline for 60 min (t=0-60 min), followed by intraduodenal saline (t=60-120 min). In obese subjects, an oral glucose tolerance test was performed. Blood glucose, serum insulin, plasma total GLP-1 and total gastric inhibitory polypeptide (GIP) were measured. RESULTS In both the groups (P<0.001), the incremental areas under the curve (iAUC)0-60 min for glucose was greater with the 3 kcal min-1 than the 1 kcal min-1 infusion; the iAUC0-120 min for glucose during 3 kcal min-1 was greater (P<0.05), in the obese. Insulin responses to 1 kcal min-1 and, particularly, 3 kcal min-1 were greater (P<0.001) in the obese. Stimulation of GLP-1 and GIP were greater (P<0.001) in response to 3 kcal min-1, compared with 1 kcal min-1 and saline, without any difference between the groups. In the obese, glycaemic, insulinaemic and GIP, but not GLP-1, responses to oral and intraduodenal glucose were related (P<0.05). CONCLUSIONS The rate of duodenal glucose delivery is a major determinant of glycaemia, insulinaemia and incretin hormone release in obese subjects. Obesity is not apparently associated with impaired GLP-1 secretion.
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Affiliation(s)
- L G Trahair
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - C S Marathe
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - S Standfield
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - C K Rayner
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - C Feinle-Bisset
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - M Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - K L Jones
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
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Abstract
Metformin is established as the first-line therapy for type 2 diabetes (T2DM), but its mode of action remains elusive. Elucidation of the mechanisms underlying the anti-diabetic action of metformin may have the potential to optimise its glucose-lowering efficacy and lead to the development of agents acting on novel targets for the management of type 2 diabetes. Areas covered: This review highlights key pharmacokinetic features of metformin, summarises recent insights into its hepatic and gastrointestinal actions relevant to blood glucose homeostasis, and discusses the common gastrointestinal side effects of metformin. Literature concerning these areas was reviewed on PubMed. Expert commentary: The mechanisms by which metformin improves glycaemic control in type 2 diabetes are complex. Although novel hepatic pathways continue to be reported in preclinical studies, there is a lack of human evidence for most of these. Considering the fundamental role of the gastrointestinal tract in the regulation of blood glucose homeostasis and pleiotropic actions of metformin on several gastrointestinal targets relevant to glycaemic control, the gut is likely to represent at least as important a site of metformin action as the liver in the management of type 2 diabetes.
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Affiliation(s)
- Tongzhi Wu
- a Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health , The University of Adelaide , Adelaide , Australia
| | - Michael Horowitz
- a Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health , The University of Adelaide , Adelaide , Australia
| | - Christopher K Rayner
- a Discipline of Medicine and Centre of Research Excellence in Translating Nutritional Science to Good Health , The University of Adelaide , Adelaide , Australia
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Marathe CS, Rayner CK, Jones KL, Horowitz M. Reactive hypoglycaemia with seizure following intraduodenal glucose infusion in a patient with type 2 diabetes. Acta Diabetol 2017; 54:215-218. [PMID: 27506657 DOI: 10.1007/s00592-016-0888-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/08/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, Adelaide, 5000, Australia.
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia.
| | - Christopher K Rayner
- Discipline of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, Adelaide, 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, Adelaide, 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, Adelaide, 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
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125
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Wu T, Xie C, Wu H, Jones KL, Horowitz M, Rayner CK. Metformin reduces the rate of small intestinal glucose absorption in type 2 diabetes. Diabetes Obes Metab 2017; 19:290-293. [PMID: 27761984 DOI: 10.1111/dom.12812] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 02/05/2023]
Abstract
In rodents, metformin slows intestinal glucose absorption, potentially increasing exposure of the distal gut to glucose to enhance postprandial glucagon-like peptide-1 (GLP-1) secretion. We evaluated the effects of metformin on serum 3-O-methylglucose (3-OMG; a marker of glucose absorption) and plasma total GLP-1 concentrations during a standardized intraduodenal infusion of glucose and 3-OMG in patients with type 2 diabetes. A total of 12 patients, treated with metformin 850 mg twice daily or placebo for 7 days each in a double-blind, randomized, crossover design (14 days' washout between treatments), were evaluated on days 5 or 8 of each treatment (6 subjects each). On each study day, 30 minutes after ingesting 850 mg metformin or placebo, patients received an infusion of glucose (60 g + 5 g 3-OMG, dissolved in water to 240 mL) via an intraduodenal catheter over the course of 120 minutes. Compared with placebo, metformin was associated with lower serum 3-OMG ( P < .001) and higher plasma total GLP-1 ( P = .003) concentrations. The increment in plasma GLP-1 after metformin vs placebo was related to the reduction in serum 3-OMG concentrations ( P = .019). Accordingly, metformin inhibits small intestinal glucose absorption, which may contribute to augmented GLP-1 secretion in type 2 diabetes.
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Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Cong Xie
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Medical School, Southeast University, Nanjing, China
| | - Hang Wu
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
- Medical School, Southeast University, Nanjing, China
| | - Karen L Jones
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher K Rayner
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
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126
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Thazhath SS, Marathe CS, Wu T, Chang J, Khoo J, Kuo P, Checklin HL, Bound MJ, Rigda RS, Horowitz M, Jones KL, Rayner CK. Acute effects of the glucagon-like peptide-1 receptor agonist, exenatide, on blood pressure and heart rate responses to intraduodenal glucose infusion in type 2 diabetes. Diab Vasc Dis Res 2017; 14:59-63. [PMID: 27941058 DOI: 10.1177/1479164116666761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the effects of the glucagon-like peptide-1 receptor agonist, exenatide, on blood pressure and heart rate during an intraduodenal glucose infusion in type 2 diabetes. METHODS Nine subjects with type 2 diabetes were randomised to receive intravenous exenatide or saline control in a crossover design. Glucose (3 kcal min-1) was infused via an intraduodenal manometry catheter for 60 min. Blood pressure, heart rate, and the frequency and amplitude of duodenal pressure waves were measured at regular intervals. Gastrointestinal symptoms were monitored using 100 mm visual analogue scales. RESULTS During intraduodenal glucose infusion (0-60 min), diastolic (p(0-60) = 0.03) and mean arterial (p(0-60) = 0.03) blood pressures and heart rate (p(0-60) = 0.06; p(0-120) = 0.03)) were higher with exenatide compared to placebo. The increase in the area under the curve for diastolic blood pressure and mean arterial blood pressure was related directly to the suppression of the duodenal motility index with exenatide compared to control (p = 0.007 and 0.04, respectively). CONCLUSION In type 2 diabetes, intravenous exenatide increases mean arterial blood pressure and heart rate during an intraduodenal glucose infusion, supporting the need for further research with exenatide for its potential use in postprandial hypotension.
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Affiliation(s)
- Sony S Thazhath
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Chinmay S Marathe
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Tongzhi Wu
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Jessica Chang
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Joan Khoo
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
- Department of Endocrinology, Changi General Hospital, Singapore
| | - Paul Kuo
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Helen L Checklin
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Michelle J Bound
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Rachael S Rigda
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Michael Horowitz
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Karen L Jones
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
| | - Christopher K Rayner
- Discipline of Medicine, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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Steinert RE, Feinle-Bisset C, Asarian L, Horowitz M, Beglinger C, Geary N. Ghrelin, CCK, GLP-1, and PYY(3-36): Secretory Controls and Physiological Roles in Eating and Glycemia in Health, Obesity, and After RYGB. Physiol Rev 2017; 97:411-463. [PMID: 28003328 PMCID: PMC6151490 DOI: 10.1152/physrev.00031.2014] [Citation(s) in RCA: 353] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The efficacy of Roux-en-Y gastric-bypass (RYGB) and other bariatric surgeries in the management of obesity and type 2 diabetes mellitus and novel developments in gastrointestinal (GI) endocrinology have renewed interest in the roles of GI hormones in the control of eating, meal-related glycemia, and obesity. Here we review the nutrient-sensing mechanisms that control the secretion of four of these hormones, ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide tyrosine tyrosine [PYY(3-36)], and their contributions to the controls of GI motor function, food intake, and meal-related increases in glycemia in healthy-weight and obese persons, as well as in RYGB patients. Their physiological roles as classical endocrine and as locally acting signals are discussed. Gastric emptying, the detection of specific digestive products by small intestinal enteroendocrine cells, and synergistic interactions among different GI loci all contribute to the secretion of ghrelin, CCK, GLP-1, and PYY(3-36). While CCK has been fully established as an endogenous endocrine control of eating in healthy-weight persons, the roles of all four hormones in eating in obese persons and following RYGB are uncertain. Similarly, only GLP-1 clearly contributes to the endocrine control of meal-related glycemia. It is likely that local signaling is involved in these hormones' actions, but methods to determine the physiological status of local signaling effects are lacking. Further research and fresh approaches are required to better understand ghrelin, CCK, GLP-1, and PYY(3-36) physiology; their roles in obesity and bariatric surgery; and their therapeutic potentials.
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Affiliation(s)
- Robert E Steinert
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Christine Feinle-Bisset
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Lori Asarian
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Michael Horowitz
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Christoph Beglinger
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Nori Geary
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
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128
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Wu T, Zhang X, Trahair LG, Bound MJ, Little TJ, Deacon CF, Horowitz M, Jones KL, Rayner CK. Small Intestinal Glucose Delivery Affects the Lowering of Blood Glucose by Acute Vildagliptin in Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:4769-4778. [PMID: 27598511 DOI: 10.1210/jc.2016-2813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT The rate of gastric emptying is an important determinant of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) secretion and may influence the magnitude of glucose lowering by dipeptidyl peptidase-4 (DPP-4) inhibitors. OBJECTIVE To evaluate the effects of the DPP-4 inhibitor, vildagliptin (VILD), during intraduodenal (ID) glucose infusion at 2 different rates within the physiological range of gastric emptying, in type 2 diabetes. PARTICIPANTS AND DESIGN A total of 16 diet-controlled type 2 diabetic patients were studied on 4 separate days in double-blind, randomized, fashion. On each day, either 5-mg VILD or placebo (PLBO) was given 60 minutes before a 120-minute ID glucose infusion at 2 or 4 kcal/min (ID2 or ID4). Plasma glucose and hormones were measured frequently. RESULTS Plasma glucose, insulin, C-peptide, glucagon, total GIP, and total and intact GLP-1 concentrations were higher during ID4 than ID2 (P < .01 for each). Compared with PLBO, VILD was associated with higher intact GLP-1, insulin, and C-peptide and lower glucose and total GIP and GLP-1 (P < .01 for each), without affecting glucagon. There were significant interactions between the rate of ID glucose and VILD treatment on plasma glucose, intact and total GLP-1, and GIP (P < .05 for each) but not insulin, C-peptide, or glucagon. The reduction in glucose and the increment in intact GLP-1 after VILD vs PLBO were 3.3- and 3.8-fold greater, respectively, during ID4 compared with ID2. CONCLUSIONS/INTERPRETATION These observations warrant further study to clarify whether type 2 diabetic patients with relatively more rapid gastric emptying have greater glucose lowering during treatment with DPP-4 inhibitors.
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Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Xiang Zhang
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Laurence G Trahair
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Michelle J Bound
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Tanya J Little
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Carolyn F Deacon
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Michael Horowitz
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Karen L Jones
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
| | - Christopher K Rayner
- Discipline of Medicine (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health (T.W., X.Z., L.G.T., M.J.B., T.J.L., M.H., K.L.J., C.K.R.), The University of Adelaide, Adelaide, Australia; and Department of Biomedical Science (C.F.D.), University of Copenhagen, Copenhagen, Denmark
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129
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Rigda RS, Trahair LG, Little TJ, Wu T, Standfield S, Feinle-Bisset C, Rayner CK, Horowitz M, Jones KL. Regional specificity of the gut-incretin response to small intestinal glucose infusion in healthy older subjects. Peptides 2016; 86:126-132. [PMID: 27780735 DOI: 10.1016/j.peptides.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 02/07/2023]
Abstract
The importance of the region, as opposed to the length, of small intestine exposed to glucose in determining the secretion of the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) remains unclear. We sought to compare the glycemic, insulinemic and incretin responses to glucose administered to the proximal (12-60cm beyond the pylorus), or more distal (>70cm beyond the pylorus) small intestine, or both. 10 healthy subjects (9M,1F; aged 70.3±1.4years) underwent infusion of glucose via a catheter into the proximal (glucose proximally; GP), or distal (glucose distally; GD) small intestine, or both (GPD), on three separate days in a randomised fashion. Blood glucose, serum insulin and plasma GLP-1, GIP and CCK responses were assessed. The iAUC for blood glucose was greater in response to GPD than GP (P<0.05), with no difference between GD and GP. GP was associated with minimal GLP-1 response (P=0.05), but substantial increases in GIP, CCK and insulin (P<0.001 for all). GPD and GD both stimulated GLP-1, GIP, CCK and insulin (P<0.001 for all). Compared to GP, GPD induced greater GLP-1, GIP and CCK responses (P<0.05 for all). Compared with GPD, GD was associated with greater GLP-1 (P<0.05), but reduced GIP and CCK (P<0.05 for both), responses. We conclude that exposure of glucose to the distal small intestine appears necessary for substantial GLP-1 secretion, while exposure of both the proximal and distal small intestine result in substantial secretion of GIP.
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Affiliation(s)
- Rachael S Rigda
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Laurence G Trahair
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Tanya J Little
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Scott Standfield
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Christine Feinle-Bisset
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, South Australia, 5000, Australia; NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, 5000, Australia.
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130
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Wu T, Rayner CK, Horowitz M. Inter-regulation of gastric emptying and incretin hormone secretion: implications for postprandial glycemic control. Biomark Med 2016; 10:1167-1179. [PMID: 27734721 DOI: 10.2217/bmm-2016-0164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The GI tract is central to the regulation of postprandial glycemia, with the rate of gastric emptying and the secretion of the incretin hormones, glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1, being key determinants. Gastric emptying exhibits a large interindividual variation; the latter not only accounts for differences in postprandial glycemia but also determines postprandial incretin profiles. Accordingly, the rate of gastric emptying may affect the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors. In contrast, glucagon-like peptide-1 receptor agonists lower postprandial glycemia predominantly by their action to slow gastric emptying. This review discusses the inter-relationship between gastric emptying and the incretin axis in the context of changes in blood glucose, with an emphasis on the relevant clinical implications.
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Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine & Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia
| | - Christopher K Rayner
- Discipline of Medicine & Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia
| | - Michael Horowitz
- Discipline of Medicine & Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia
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131
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Ullrich SS, Fitzgerald PC, Schober G, Steinert RE, Horowitz M, Feinle-Bisset C. Intragastric administration of leucine or isoleucine lowers the blood glucose response to a mixed-nutrient drink by different mechanisms in healthy, lean volunteers. Am J Clin Nutr 2016; 104:1274-1284. [PMID: 27655440 DOI: 10.3945/ajcn.116.140640] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/19/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The branched-chain amino acids leucine and isoleucine lower blood glucose after oral glucose ingestion, and the intraduodenal infusion of leucine decreases energy intake in healthy, lean men. OBJECTIVE We investigated the effects of the intragastric administration of leucine and isoleucine on the gastric emptying of, and blood glucose responses to, a physiologic mixed-macronutrient drink and subsequent energy intake. DESIGN In 2 separate studies, 12 healthy, lean subjects received on 3 separate occasions an intragastric infusion of 5 g leucine (leucine-5g) or an intragastric infusion of 10 g leucine (leucine-10g), an intragastric infusion of 5 g isoleucine (isoleucine-5g) or an intragastric infusion of 10 g isoleucine (isoleucine-10g), or a control. Fifteen minutes later, subjects consumed a mixed-nutrient drink (400 kcal, 56 g carbohydrates, 15 g protein, and 12 g fat), and gastric emptying (13C-acetate breath test) and blood glucose, plasma insulin, C-peptide, glucagon, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and cholecystokinin (leucine study only) were measured for 60 min. Immediately afterward, energy intake from a cold, buffet-style meal was assessed. RESULTS Compared with the control, leucine-10g decreased the blood glucose area under the curve (AUC) (P < 0.05) and tended to reduce peak blood glucose (P = 0.07), whereas effects of leucine-5g were NS. Leucine-10g, but not leucine-5g, increased plasma insulin and C-peptide AUCs (P < 0.01 for both), but neither dose affected glucagon, GLP-1, GIP, cholecystokinin, gastric emptying, or energy intake. Compared with the control, isoleucine-10g reduced the blood glucose AUC and peak blood glucose (P < 0.01), whereas effects of isoleucine-5g were NS. Neither load affected insulin, C-peptide, glucagon, GLP-1, or GIP. Isoleucine-10g, but not isoleucine-5g, slowed gastric emptying (P < 0.05), but gastric emptying was not correlated with the blood glucose AUC. Isoleucine did not affect energy intake. CONCLUSIONS In healthy subjects, both leucine and isoleucine reduced blood glucose in response to a mixed-nutrient drink but did not affect subsequent energy intake. The mechanisms underlying glucose lowering appear to differ; leucine stimulated insulin, whereas isoleucine acted insulin independently. These trials were registered at www.anzctr.org.au as 12613000899741 and 12614000837628.
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Affiliation(s)
- Sina S Ullrich
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Penelope Ce Fitzgerald
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Gudrun Schober
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Robert E Steinert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Christine Feinle-Bisset
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; and National Health and Medical Research Council of Australia Center of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
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132
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Ali Abdelhamid Y, Kar P, Finnis ME, Phillips LK, Plummer MP, Shaw JE, Horowitz M, Deane AM. Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis. Crit Care 2016; 20:301. [PMID: 27677709 PMCID: PMC5039881 DOI: 10.1186/s13054-016-1471-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hyperglycaemia occurs frequently in critically ill patients without diabetes. We conducted a systematic review and meta-analysis to evaluate whether this 'stress hyperglycaemia' identifies survivors of critical illness at increased risk of subsequently developing diabetes. METHODS We searched the MEDLINE and Embase databases from their inception to February 2016. We included observational studies evaluating adults admitted to the intensive care unit (ICU) who developed stress hyperglycaemia if the researchers reported incident diabetes or prediabetes diagnosed ≥3 months after hospital discharge. Two reviewers independently screened the titles and abstracts of identified studies and evaluated the full text of relevant studies. Data were extracted using pre-defined data fields, and risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled ORs with 95 % CIs for the occurrence of diabetes were calculated using a random-effects model. RESULTS Four cohort studies provided 2923 participants, including 698 with stress hyperglycaemia and 131 cases of newly diagnosed diabetes. Stress hyperglycaemia was associated with increased risk of incident diabetes (OR 3.48; 95 % CI 2.02-5.98; I 2 = 36.5 %). Studies differed with regard to definitions of stress hyperglycaemia, follow-up and cohorts studied. CONCLUSIONS Stress hyperglycaemia during ICU admission is associated with increased risk of incident diabetes. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies.
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Affiliation(s)
- Yasmine Ali Abdelhamid
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Palash Kar
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Mark E. Finnis
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Liza K. Phillips
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - Mark P. Plummer
- Intensive Care Unit, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ UK
| | - Jonathan E. Shaw
- Clinical Diabetes Laboratory, Baker IDI, 75 Commercial Road, Melbourne, VIC 3004 Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - Adam M. Deane
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA 5005 Australia
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133
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Plummer MP, Kar P, Cousins CE, Hausken T, Lange K, Chapman MJ, Jones KL, Horowitz M, Deane AM. Critical Illness Is Associated With Impaired Gallbladder Emptying as Assessed by 3D Ultrasound. Crit Care Med 2016; 44:e790-6. [PMID: 27071067 DOI: 10.1097/ccm.0000000000001715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To quantify gallbladder dysfunction during critical illness. DESIGN Prospective observational comparison study of nutrient-stimulated gallbladder emptying in health and critical illness. SETTING Single-centre mixed medical/surgical ICU. PATIENTS Twenty-four mechanically ventilated critically ill patients suitable to receive enteral nutrition were compared with 12 healthy subjects. INTERVENTIONS Participants were studied after an 8-hour fast. Between 0 and 120 minutes, high-fat nutrient (20% intralipid) was infused via a postpyloric catheter into the duodenum at 2 kcal/min. MEASUREMENTS AND MAIN RESULTS Three-dimensional images of the gallbladder were acquired at 30-minute intervals from -30 to 180 minutes. Ejection fraction (%) was calculated as changes between 0 and 120 minutes. Blood samples were obtained at 30-minute intervals for plasma cholecystokinin. Data are mean (SD) or median [interquartile range]. In the critically ill, fasting gallbladder volumes (critically ill, 61 mL [36-100 mL] vs healthy, 22 mL [15-25] mL; p < 0.001] and wall thickness (0.45 mm [0.15 mm] vs 0.26 mm [0.08 mm]; p < 0.001] were substantially greater, and sludge was evident in the majority of patients (71% vs 0%). Nutrient-stimulated emptying was incomplete in the critically ill after 120 minutes but was essentially complete in the healthy individuals (22 mL [9-66 mL] vs 4 mL [3-5 mL]; p < 0.01]. In five critically ill patients (21%), there was no change in gallbladder volume in response to nutrient, and overall ejection fraction was reduced in the critically ill (50% [8-83%] vs 77 [72-84%]; p = 0.01]. There were no differences in fasting or incremental cholecystokinin concentrations. CONCLUSIONS Fasted critically ill patients have larger, thicker-walled gallbladders than healthy subjects and nutrient-stimulated gallbladder emptying is impaired with "gallbladder paresis" occurring in approximately 20%.
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Affiliation(s)
- Mark P Plummer
- 1Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.2Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.3Department of Medicine, Haukeland University Hospital, Bergen, Norway.4Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
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134
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Schober G, Lange K, Steinert RE, Hutchison AT, Luscombe-Marsh ND, Landrock MF, Horowitz M, Seimon RV, Feinle-Bisset C. Contributions of upper gut hormones and motility to the energy intake-suppressant effects of intraduodenal nutrients in healthy, lean men - a pooled-data analysis. Physiol Rep 2016; 4:e12943. [PMID: 27613824 PMCID: PMC5027351 DOI: 10.14814/phy2.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023] Open
Abstract
We have previously identified pyloric pressures and plasma cholecystokinin (CCK) concentrations as independent determinants of energy intake following administration of intraduodenal lipid and intravenous CCK. We evaluated in healthy men whether these parameters also determine energy intake in response to intraduodenal protein, and whether, across the nutrients, any predominant gastrointestinal (GI) factors exist, or many factors make small contributions. Data from nine published studies, in which antropyloroduodenal pressures, GI hormones, and GI /appetite perceptions were measured during intraduodenal lipid or protein infusions, were pooled. In all studies energy intake was quantified immediately after the infusions. Specific variables for inclusion in a mixed-effects multivariable model for determination of independent predictors of energy intake were chosen following assessment for collinearity, and within-subject correlations between energy intake and these variables were determined using bivariate analyses adjusted for repeated measures. In models based on all studies, or lipid studies, there were significant effects for amplitude of antral pressure waves, premeal glucagon-like peptide-1 (GLP-1) and time-to-peak GLP-1 concentrations, GLP-1 AUC and bloating scores (P < 0.05), and trends for basal pyloric pressure (BPP), amplitude of duodenal pressure waves, peak CCK concentrations, and hunger and nausea scores (0.05 < P ≤ 0.094), to be independent determinants of subsequent energy intake. In the model including the protein studies, only BPP was identified as an independent determinant of energy intake (P < 0.05). No single parameter was identified across all models, and effects of the variables identified were relatively small. Taken together, while GI mechanisms contribute to the regulation of acute energy intake by lipid and protein, their contribution to the latter is much less. Moreover, the effects are likely to reflect small, cumulative contributions from a range of interrelated factors.
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Affiliation(s)
- Gudrun Schober
- University of Adelaide Discipline of Medicine, Adelaide, Australia
| | - Kylie Lange
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
| | - Robert E Steinert
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
| | - Amy T Hutchison
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Natalie D Luscombe-Marsh
- NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia CSIRO Animal, Food and Health Sciences, Adelaide, Australia
| | - Maria F Landrock
- University of Adelaide Discipline of Medicine, Adelaide, Australia
| | - Michael Horowitz
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
| | - Radhika V Seimon
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Christine Feinle-Bisset
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
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Kar P, Plummer MP, Bellomo R, Jenkins AJ, Januszewski AS, Chapman MJ, Jones KL, Horowitz M, Deane AM. Liberal Glycemic Control in Critically Ill Patients With Type 2 Diabetes: An Exploratory Study. Crit Care Med 2016; 44:1695-703. [PMID: 27315191 DOI: 10.1097/ccm.0000000000001815] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The optimal blood glucose target in critically ill patients with preexisting diabetes and chronic hyperglycemia is unknown. In such patients, we aimed to determine whether a " liberal" approach to glycemic control would reduce hypoglycemia and glycemic variability and appear safe. DESIGN Prospective, open-label, sequential-period exploratory study. SETTING Medical-surgical ICU. PATIENTS During sequential 6-month periods, we studied 83 patients with preexisting type 2 diabetes and chronic hyperglycemia (glycated hemoglobin, ≥ 7.0% at ICU admission). INTERVENTION During the "standard care" period, 52 patients received insulin to treat blood glucose concentrations greater than 10 mmol/L whereas during the "liberal" period, 31 patients received insulin to treat blood glucose concentrations greater than 14 mmol/L. MEASUREMENTS AND MAIN RESULTS Time-weighted mean glucose concentrations and the number and duration of moderate (< 4.0 mmol/L) and severe (≤ 2.2 mmol/L) hypoglycemic episodes were recorded, with moderate and severe hypoglycemic episodes grouped together. Glycemic variability was assessed by calculating the coefficient of variability for each patient. Safety was evaluated using clinical outcomes and plasma concentrations of markers of inflammation, glucose-turnover, and oxidative stress. Mean glucose (TWglucoseday 0-7, standard care: 9.3 [1.8] vs liberal: 10.3 [2.1] mmol/L; p = 0.02) and nadir blood glucose (4.4 [1.5] vs 5.5 [1.6] mmol/L; p < 0.01) were increased during the liberal period. There was a signal toward reduced risk of moderate-severe hypoglycemia (relative risk: liberal compared with standard care: 0.47 [95% CI, 0.19-1.13]; p = 0.09). Ten patients (19%) during the standard period and one patient (3%) during the liberal period had recurrent episodes of moderate-severe hypoglycemia. Liberal therapy reduced glycemic variability (coefficient of variability, 33.2% [12.9%] vs 23.8% [7.7%]; p < 0.01). Biomarker data and clinical outcomes were similar. CONCLUSIONS In critically ill patients with type 2 diabetes and chronic hyperglycaemia, liberal glycemic control appears to attenuate glycemic variability and may reduce the prevalence of moderate-severe hypoglycemia.
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Affiliation(s)
- Palash Kar
- 1Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.2Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.3Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.4School of Medicine, The University of Melbourne, Melbourne, VIC, Australia.5Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.6National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.7National Health and Medical Research Council Centre of Research Excellence (CRE) in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, SA, Australia.8Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
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Kar P, Plummer MP, Chapman MJ, Cousins CE, Lange K, Horowitz M, Jones KL, Deane AM. Energy-Dense Formulae May Slow Gastric Emptying in the Critically Ill. JPEN J Parenter Enteral Nutr 2016; 40:1050-6. [PMID: 26038421 DOI: 10.1177/0148607115588333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/11/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Enteral feed intolerance occurs frequently in critically ill patients and can be associated with adverse outcomes. "Energy-dense formulae" (ie, >1 kcal/mL) are often prescribed to critically ill patients to reduce administered volume and are presumed to maintain or increase calorie delivery. The aim of this study was to compare gastric emptying of standard and energy-dense formulae in critically ill patients. METHODS In a retrospective comparison of 2 studies, data were analyzed from 2 groups of patients that received a radiolabeled 100-mL "meal" containing either standard calories (1 kcal/mL) or concentrated calories (energy-dense formulae; 2 kcal/mL). Gastric emptying was measured using a scintigraphic technique. Radioisotope data were collected for 4 hours and gastric emptying quantified. Data are presented as mean ± SE or median [interquartile range] as appropriate. RESULTS Forty patients were studied (n = 18, energy-dense formulae; n = 22, standard). Groups were well matched in terms of demographics. However, patients in the energy-dense formula group were studied earlier in their intensive care unit admission (P = .02) and had a greater proportion requiring inotropes (P = .002). A similar amount of calories emptied out of the stomach per unit time (P = .57), but in patients receiving energy-dense formulae, a greater volume of meal was retained in the stomach (P = .045), consistent with slower gastric emptying. CONCLUSIONS In critically ill patients, the administration of the same volume of a concentrated enteral nutrition formula may not result in the delivery of more calories to the small intestine over time because gastric emptying is slowed.
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Affiliation(s)
- Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Mark P Plummer
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | | | - Kylie Lange
- National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
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Affiliation(s)
- Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Adam M Deane
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
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Abstract
The gastrointestinal tract plays a major role in the regulation of postprandial glucose profiles. Gastric emptying is a highly regulated process, which normally ensures a limited and fairly constant delivery of nutrients and glucose to the proximal gut. The subsequent digestion and absorption of nutrients are associated with the release of a set of hormones that feeds back to regulate subsequent gastric emptying and regulates the release of insulin, resulting in downregulation of hepatic glucose production and deposition of glucose in insulin-sensitive tissues. These remarkable mechanisms normally keep postprandial glucose excursions low, regardless of the load of glucose ingested. When the regulation of emptying is perturbed (e.g., pyloroplasty, gastric sleeve or gastric bypass operation), postprandial glycemia may reach high levels, sometimes followed by profound hypoglycemia. This article discusses the underlying mechanisms.
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Affiliation(s)
- Jens Juul Holst
- The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fiona Gribble
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, U.K
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Chris K Rayner
- Discipline of Medicine, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Trahair LG, Kimber TE, Flabouris K, Horowitz M, Jones KL. Gastric emptying, postprandial blood pressure, glycaemia and splanchnic flow in Parkinson’s disease. World J Gastroenterol 2016; 22:4860-4867. [PMID: 27239112 PMCID: PMC4873878 DOI: 10.3748/wjg.v22.i20.4860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/27/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine gastric emptying, blood pressure, mesenteric artery blood flow, and blood glucose responses to oral glucose in Parkinson’s disease.
METHODS: Twenty-one subjects (13 M, 8 F; age 64.2 ± 1.6 years) with mild to moderate Parkinson’s disease (Hoehn and Yahr score 1.4 ± 0.1, duration of known disease 6.3 ± 0.9 years) consumed a 75 g glucose drink, labelled with 20 MBq 99mTc-calcium phytate. Gastric emptying was quantified with scintigraphy, blood pressure and heart rate with an automated device, superior mesenteric artery blood flow by Doppler ultrasonography and blood glucose by glucometer for 180 min. Autonomic nerve function was evaluated with cardiovascular reflex tests and upper gastrointestinal symptoms by questionnaire.
RESULTS: The mean gastric half-emptying time was 106 ± 9.1 min, gastric emptying was abnormally delayed in 3 subjects (14%). Systolic and diastolic blood pressure fell (P < 0.001) and mesenteric blood flow and blood glucose (P < 0.001 for both) increased, following the drink. Three subjects (14%) had definite autonomic neuropathy and 8 (38%) had postprandial hypotension. There were no significant relationships between changes in blood pressure, heart rate or mesenteric artery blood flow with gastric emptying. Gastric emptying was related to the score for autonomic nerve function (R = 0.55, P < 0.01). There was an inverse relationship between the blood glucose at t = 30 min (R = -0.52, P < 0.05), while the blood glucose at t = 180 min was related directly (R = 0.49, P < 0.05), with gastric emptying.
CONCLUSION: In mild to moderate Parkinson’s disease, gastric emptying is related to autonomic dysfunction and a determinant of the glycaemic response to oral glucose.
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Plummer MP, Kar P, Cousins CE, Lange K, Chapman MJ, Nauck MA, Horowitz M, Meier JJ, Deane AM. The insulinotropic effect of pulsatile compared with continuous intravenous delivery of GLP-1. Diabetologia 2016; 59:966-9. [PMID: 26831299 DOI: 10.1007/s00125-016-3878-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/06/2016] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS In healthy individuals, both insulin and glucagon-like peptide 1 (GLP-1) are secreted in a pulsatile fashion. Insulin has greater glucose-lowering properties when administered in pulses compared with a constant i.v. infusion. The primary aim of this randomised double-dummy cross-over study was to compare the insulinotropic response to pulsatile and continuous i.v. infusions of equivalent doses of GLP-1. METHODS Twelve healthy participants aged 18-35 years were randomised to three different treatments on separate days: a continuous infusion day (GLP-1 at 0.6 pmol kg(-1) min(-1) [1 ml/min] and a 1 ml placebo bolus every 6 min); a pulsatile infusion day (placebo at 1 ml/min and a 3.6 pmol/kg GLP-1 bolus every 6 min); and a placebo day (placebo at 1 ml/min and a 1 ml placebo bolus every 6 min). Between 45 and 120 min, a hyperglycaemic clamp was used to maintain blood glucose at 9 mmol/l. Venous blood glucose and plasma insulin concentrations were measured every 5 min from 0 to 45 min and every 1 min from 45 to 120 min; plasma glucagon was measured every 15 min. The order of treatment was randomised by the Pharmacy Department and both study investigators and participants were blinded to the treatment arm. The dextrose requirement and glucagon data were analysed using repeated measures ANOVA and insulin data were analysed with a linear mixed effects maximum likelihood model. RESULTS Continuous and pulsatile infusions of GLP-1 increased the dextrose requirement by ~threefold (p < 0.001) and increased insulin secretion by ~ninefold (p < 0.001). There was no difference in the effect of both treatments. Although hyperglycaemia reduced plasma glucagon concentrations, there was no difference between the treatment days. CONCLUSIONS/INTERPRETATION In healthy individuals, pulsatile and continuous administration of i.v. GLP-1 appears to have comparable insulinotropic effects. TRIAL REGISTRATION ACTRN12612001040853 FUNDING: This study was supported by the National Health and Medical Research Council (NHMRC) of Australia.
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Affiliation(s)
- Mark P Plummer
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
- Intensive Care Research Unit, Level 4 Emergency Block, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.
| | - Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Intensive Care Research Unit, Level 4 Emergency Block, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | - Caroline E Cousins
- Intensive Care Research Unit, Level 4 Emergency Block, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | - Kylie Lange
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Intensive Care Research Unit, Level 4 Emergency Block, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | - Michael A Nauck
- Division of Diabetes and GI Endocrinology, University Hospital St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Juris J Meier
- Division of Diabetes and GI Endocrinology, University Hospital St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
- Intensive Care Research Unit, Level 4 Emergency Block, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
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Thazhath SS, Wu T, Bound MJ, Checklin HL, Standfield S, Jones KL, Horowitz M, Rayner CK. Effects of intraduodenal hydroxycitrate on glucose absorption, incretin release, and glycemia in response to intraduodenal glucose infusion in health and type 2 diabetes: A randomised controlled trial. Nutrition 2016; 32:553-9. [PMID: 26792024 DOI: 10.1016/j.nut.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hydroxycitric acid (HCA), derived from the fruit Garcinia cambogia, reduces the rate of glucose absorption and lowers postprandial glycemia in rodents, but its effect in humans is unknown. The aim of this study was to investigate the effects of small intestinal perfusion with HCA on glucose absorption, as well as the incretin and glycemic responses to a subsequent intraduodenal glucose infusion, in both healthy individuals and patients with type 2 diabetes. METHODS Twelve healthy participants and 8 patients with type 2 diabetes received an intraduodenal infusion of HCA (2800 mg in water) or control (water) over 60 min, followed by an intraduodenal infusion of 60 g glucose over 120 min, in a double-blind, randomized crossover design. In healthy individuals, 5 g 3-O-methylglucose (3-OMG) was co-infused with glucose as a marker of glucose absorption. Blood was sampled frequently. RESULTS In healthy individuals, blood glucose was lower with HCA than control, both before and during the intraduodenal glucose infusion (P < 0.05 for each). Plasma glucose-dependent insulinotropic polypeptide (GIP; P = 0.01) and glucagon (P = 0.06) were higher with HCA, but there were no differences in plasma glucagon-like peptide (GLP)-1, insulin, or serum 3-OMG concentrations. In patients with type 2 diabetes, blood glucose, and plasma GIP, GLP-1, and insulin did not differ between HCA and control either before or after intraduodenal glucose, but during glucose infusion, plasma glucagon was higher with HCA (P = 0.04). CONCLUSION In healthy individuals, small intestinal exposure to HCA resulted in a modest reduction in glycemia and stimulation of plasma GIP and glucagon, but no effect on plasma GLP-1 or insulin, or on glucose absorption. HCA had no effect on glycemia in patients with type 2 diabetes.
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Affiliation(s)
- Sony S Thazhath
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michelle J Bound
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Helen L Checklin
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Scott Standfield
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.
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Wu T, Little TJ, Bound MJ, Borg M, Zhang X, Deacon CF, Horowitz M, Jones KL, Rayner CK. A Protein Preload Enhances the Glucose-Lowering Efficacy of Vildagliptin in Type 2 Diabetes. Diabetes Care 2016; 39:511-7. [PMID: 26786576 DOI: 10.2337/dc15-2298] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/24/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Nutrient "preloads" given before meals can attenuate postprandial glycemic excursions, at least partly by slowing gastric emptying and stimulating secretion of the incretins (i.e., glucagon-like peptide-1 [GLP-1] and glucose-dependent insulinotropic polypeptide [GIP]). This study was designed to evaluate whether a protein preload could improve the efficacy of the dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin to increase incretin concentrations, slow gastric emptying, and lower postprandial glycemia in type 2 diabetes. RESEARCH DESIGN AND METHODS Twenty-two patients with type 2 diabetes treated with metformin were studied on four occasions, receiving either 50 mg vildagliptin (VILD) or placebo (PLBO) on both the evening before and the morning of each study day. The latter dose was followed after 60 min by a preload drink containing either 25 g whey protein (WHEY) or control flavoring (CTRL), and after another 30 min by a (13)C-octanoate-labeled mashed potato meal. Plasma glucose and hormones, and gastric emptying, were evaluated. RESULTS Compared with PLBO/CTRL, PLBO/WHEY reduced postprandial peak glycemia, increased plasma insulin, glucagon, and incretin hormones (total and intact), and slowed gastric emptying, whereas VILD/CTRL reduced both the peak and area under the curve for glucose, increased plasma intact incretins, and slowed gastric emptying but suppressed plasma glucagon and total incretins (P < 0.05 each). Compared with both PLBO/WHEY and VILD/CTRL, VILD/WHEY was associated with higher plasma intact GLP-1 and GIP, slower gastric emptying, and lower postprandial glycemia (P < 0.05 each). CONCLUSIONS In metformin-treated type 2 diabetes, a protein preload has the capacity to enhance the efficacy of vildagliptin to slow gastric emptying, increase plasma intact incretins, and reduce postprandial glycemia.
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Affiliation(s)
- Tongzhi Wu
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Tanya J Little
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Michelle J Bound
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Malcolm Borg
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
| | - Xiang Zhang
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Carolyn F Deacon
- Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Michael Horowitz
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Smith RC, Smith SF, Wilson J, Pearce C, Wray N, Vo R, Chen J, Ooi CY, Oliver M, Katz T, Turner R, Nikfarjam M, Rayner C, Horowitz M, Holtmann G, Talley N, Windsor J, Pirola R, Neale R. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. Pancreatology 2016; 16:164-80. [PMID: 26775768 DOI: 10.1016/j.pan.2015.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023]
Abstract
AIM Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI). METHODS A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category. RESULTS AND CONCLUSIONS Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the 'unlikely' PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000-40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy.
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Affiliation(s)
| | - Ross C Smith
- Department of Surgery, University of Sydney, NSW, Australia; Australasian Pancreatic Club, Australia.
| | | | | | - Callum Pearce
- Institute for Immunology and Infectious Diseases, Murdoch University, WA, Australia; Fremantle Hospital, WA, Australia
| | - Nick Wray
- Nutrition & Dietetics, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ruth Vo
- Liverpool Hospital, University of NSW, Australia
| | - John Chen
- South Australian Liver Transplant & HPB Unit, RAH & Flinders Medical Centre, SA, Australia
| | - Chee Y Ooi
- School of Women's and Children's Health, Dept. of Medicine, University of NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Mark Oliver
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia
| | - Tamarah Katz
- Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard Turner
- Hobart Clinical School and Dept. Surgery, University of Tasmania, Australia
| | - Mehrdad Nikfarjam
- Dept. Surgery, University of Melbourne, VIC, Australia; Australasian Pancreatic Club, Australia
| | - Christopher Rayner
- School of Medicine, University of Adelaide, SA, Australia; Centre for Digestive Diseases, Royal Adelaide Hospital, SA, Australia
| | - Michael Horowitz
- Endocrine and Metabolic Unit, University of Adelaide and Royal Adelaide Hospital, SA, Australia
| | - Gerald Holtmann
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia; Translational Research Institute, Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Qld, Australia
| | - Nick Talley
- Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Royal Australasian College of Physicians, Australia
| | - John Windsor
- Dept. of Surgery, University of Auckland, New Zealand
| | - Ron Pirola
- Faculty of Medicine, SW Sydney Clinical School, University of NSW, Australia
| | - Rachel Neale
- Cancer Control Laboratory, Queensland Institute of Medical Research, Qld, Australia
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Marathe CS, Horowitz M, Trahair LG, Bound M, Checklin H, Lange K, Rayner CK, Jones KL. Effect of duodenal glucose load on blood pressure in type 2 diabetes. Diabetes Res Clin Pract 2016; 113:38-40. [PMID: 26972959 DOI: 10.1016/j.diabres.2016.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/14/2016] [Accepted: 01/17/2016] [Indexed: 02/07/2023]
Abstract
Postprandial hypotension occurs frequently in diabetes. We show in 9 type 2 patients, that the fall in systolic blood pressure is greater in response to intraduodenal glucose infused at 4 kcal/min than 2 kcal/min, implying that strategies to slow gastric emptying may be effective in the management of postprandial hypotension.
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Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia.
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Laurence G Trahair
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Michelle Bound
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Helen Checklin
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Kylie Lange
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
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Marathe CS, Rayner CK, Jones KL, Horowitz M. Letter to the Editor: One-Hour Postload Hyperglycemia is a Stronger Predictor of Type 2 Diabetes than Impaired Fasting Glucose. J Clin Endocrinol Metab 2016; 101:L33-4. [PMID: 26840117 DOI: 10.1210/jc.2015-4138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Chinmay S Marathe
- Discipline of Medicine (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Royal Adelaide Hospital, and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Royal Adelaide Hospital, and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- Discipline of Medicine (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Royal Adelaide Hospital, and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Royal Adelaide Hospital, and Centre of Research Excellence in Translating Nutritional Science to Good Health (C.S.M., C.K.R., K.L.J., M.H.), The University of Adelaide, Adelaide, Australia
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146
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Giezenaar C, Chapman I, Luscombe-Marsh N, Feinle-Bisset C, Horowitz M, Soenen S. Ageing Is Associated with Decreases in Appetite and Energy Intake--A Meta-Analysis in Healthy Adults. Nutrients 2016; 8:nu8010028. [PMID: 26751475 PMCID: PMC4728642 DOI: 10.3390/nu8010028] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/07/2015] [Accepted: 12/22/2015] [Indexed: 02/07/2023] Open
Abstract
It is not well recognized that in the elderly weight loss is more common than weight gain. The aim of this analysis was to determine the effect of ageing on appetite (hunger/fullness) and energy intake, after overnight fasting and in a postprandial state, by meta-analyses of trials that included at least two age groups (>18 years). We hypothesized that appetite and energy intake would be less in healthy older compared with younger adults. Following a PubMed-database systematic search up to 30 June 2015, 59 studies were included in the random-effects-model meta-analyses. Energy intake was 16%-20% lower in older (n = 3574/~70 years/~71 kg/~25 kg/m²) than younger (n = 4111/~26 years/~69 kg/~23 kg/m²) adults (standardized mean difference: -0.77 (95% confidence interval -0.90 to -0.64)). Hunger was 25% (after overnight fasting; weighted mean difference (WMD): -17 (-22 to -13) mm) to 39% (in a postprandial state; WMD: -14 (-19 to -9) mm) lower, and fullness 37% (after overnight fasting; WMD: 6 mm (95% CI: 1 to 11 mm)) greater in older than younger adults. In conclusion, appetite and energy intake are less in healthy older than younger adults, suggesting that ageing per se affects food intake.
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Affiliation(s)
- Caroline Giezenaar
- Discipline of Medicine, National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, the University of Adelaide, 5000 Adelaide, Australia.
| | - Ian Chapman
- Discipline of Medicine, National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, the University of Adelaide, 5000 Adelaide, Australia.
| | - Natalie Luscombe-Marsh
- Discipline of Medicine, National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, the University of Adelaide, 5000 Adelaide, Australia.
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Food and Nutrition, 5000 Adelaide, Australia.
| | - Christine Feinle-Bisset
- Discipline of Medicine, National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, the University of Adelaide, 5000 Adelaide, Australia.
| | - Michael Horowitz
- Discipline of Medicine, National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, the University of Adelaide, 5000 Adelaide, Australia.
| | - Stijn Soenen
- Discipline of Medicine, National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, the University of Adelaide, 5000 Adelaide, Australia.
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147
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Luscombe-Marsh ND, Hutchison AT, Soenen S, Steinert RE, Clifton PM, Horowitz M, Feinle-Bisset C. Plasma Free Amino Acid Responses to Intraduodenal Whey Protein, and Relationships with Insulin, Glucagon-Like Peptide-1 and Energy Intake in Lean Healthy Men. Nutrients 2016; 8:nu8010004. [PMID: 26742062 PMCID: PMC4728618 DOI: 10.3390/nu8010004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 02/07/2023] Open
Abstract
This study determined the effects of increasing loads of intraduodenal (ID) dairy protein on plasma amino acid (AA) concentrations, and their relationships with serum insulin, plasma glucagon-like peptide-1 (GLP-1) and energy intake. Sixteen healthy men had concentrations of AAs, GLP-1 and insulin measured in response to 60-min ID infusions of hydrolysed whey protein administered, in double-blinded and randomised order, at 2.1 (P2.1), 6.3 (P6.3) or 12.5 (P12.5) kJ/min (encompassing the range of nutrient emptying from the stomach), or saline control (C). Energy intake was quantified immediately afterwards. Compared with C, the concentrations of 19/20 AAs, the exception being cysteine, were increased, and this was dependent on the protein load. The relationship between AA concentrations in the infusions and the area under the curve from 0 to 60 min (AUC0-60 min) of each AA profile was strong for essential AAs (R² range, 0.61-0.67), but more variable for non-essential (0.02-0.54) and conditional (0.006-0.64) AAs. The AUC0-60 min for each AA was correlated directly with the AUC0-60 min of insulin (R² range 0.3-0.6), GLP-1 (0.2-0.6) and energy intake (0.09-0.3) (p < 0.05, for all), with the strongest correlations being for branched-chain AAs, lysine, methionine and tyrosine. These findings indicate that ID whey protein infused at loads encompassing the normal range of gastric emptying increases plasma concentrations of 19/20 AAs in a load-dependent manner, and provide novel information on the close relationships between the essential AAs, leucine, valine, isoleucine, lysine, methionine, and the conditionally-essential AA, tyrosine, with energy intake, insulin and GLP-1.
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Affiliation(s)
- Natalie D Luscombe-Marsh
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide Discipline of Medicine, Adelaide 5000, Australia.
- CSIRO Food and Nutrition, PO Box 10041 Adelaide BC, Adelaide SA 5000, Australia.
| | - Amy T Hutchison
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide Discipline of Medicine, Adelaide 5000, Australia.
| | - Stijn Soenen
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide Discipline of Medicine, Adelaide 5000, Australia.
| | - Robert E Steinert
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide Discipline of Medicine, Adelaide 5000, Australia.
| | - Peter M Clifton
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide Discipline of Medicine, Adelaide 5000, Australia.
- School of Pharmacology and Medical Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Michael Horowitz
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide Discipline of Medicine, Adelaide 5000, Australia.
| | - Christine Feinle-Bisset
- NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide Discipline of Medicine, Adelaide 5000, Australia.
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148
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Plummer MP, Finnis ME, Phillips LK, Kar P, Bihari S, Biradar V, Moodie S, Horowitz M, Shaw JE, Deane AM. Stress Induced Hyperglycemia and the Subsequent Risk of Type 2 Diabetes in Survivors of Critical Illness. PLoS One 2016; 11:e0165923. [PMID: 27824898 PMCID: PMC5100960 DOI: 10.1371/journal.pone.0165923] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/19/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Stress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness. DESIGN Retrospective cohort study. SETTING All adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011. PATIENTS Stress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression. MAIN RESULTS Stress induced hyperglycemia was identified in 2,883 (17%) of 17,074 patients without diabetes. The incidence of type 2 diabetes following critical illness was 4.8% (821 of 17,074). The risk of diabetes in patients with stress induced hyperglycemia was approximately double that of those without (HR 1.91 (95% CI 1.62, 2.26), p<0.001) and was sustained regardless of age or severity of illness. CONCLUSIONS Stress induced hyperglycemia identifies patients at subsequent risk of incident diabetes.
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Affiliation(s)
- Mark P. Plummer
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia
- * E-mail:
| | - Mark E. Finnis
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia
| | - Liza K. Phillips
- Discipline of Medicine, University of Adelaide, Level 6 Eleanor Harrald Building, Adelaide, South Australia, Australia
- Department of Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Palash Kar
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia
| | - Shailesh Bihari
- Department of Critical Care Medicine, Flinders University, Bedford Park, South Australia, Australia
- Department of Intensive Care Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Vishwanath Biradar
- Department of Intensive Care Medicine, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Stewart Moodie
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Level 6 Eleanor Harrald Building, Adelaide, South Australia, Australia
- Department of Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jonathan E. Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Adam M. Deane
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Level 5 Eleanor Harrald Building, Adelaide, South Australia, Australia
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149
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Abstract
PURPOSE OF REVIEW This article reviews the impact of ageing on the gastrointestinal tract, including effects on the absorption of nutrients and drugs and the gastrointestinal tract defence system against ingested pathogens. RECENT FINDINGS Recent publications support earlier observations of an age-related selective decline in gut function including changes in taste, oesophageal sphincter motility, gastric emptying, and neurons of the myenteric plexus related to gut transit which may impact the nutritional status. Ageing is also associated with structural and functional mucosal defence defects, diminished abilities to generate protective immunity, and increased incidence of inflammation and oxidative stress. A number of gastrointestinal disorders occur more frequently in the elderly population. SUMMARY Alterations in gut function with ageing have particular implications for oesophageal, gastric, and colonic motility. Older individuals are particularly susceptible to malnutrition, postprandial hypotension, dysphagia, constipation, and faecal incontinence. Decrease in the number of nerve cells of the myenteric plexus that impact digestive absorption and the surface area of the small intestine because of degeneration of villi may lead to blunted absorption of nutrients. Impairment of the intestinal immune system as a result of ageing, including the mucosal layer of the gastrointestinal tract, appears to be a significant contributor to the age-related increase in the incidence and severity of infections.
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Affiliation(s)
- Stijn Soenen
- National Health and Medical Research Council of Australia (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, South Australia, Australia
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150
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Nguyen NQ, Debreceni TL, Burgstad CM, Neo M, Bellon M, Wishart JM, Standfield S, Bartholomeusz D, Rayner CK, Wittert G, Horowitz M. Effects of Fat and Protein Preloads on Pouch Emptying, Intestinal Transit, Glycaemia, Gut Hormones, Glucose Absorption, Blood Pressure and Gastrointestinal Symptoms After Roux-en-Y Gastric Bypass. Obes Surg 2016; 26:77-84. [PMID: 25986427 DOI: 10.1007/s11695-015-1722-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim was to determine the effects of fat and protein preloads on pouch emptying (PE), caecal arrival time (CAT), glucose absorption, blood glucose (BSL), gut hormones, haemodynamics and gastrointestinal (GI) symptoms in subjects who had undergone Roux-en-Y gastric bypass (RYGB) >12 months previously. METHODS Ten RYGB subjects were studied on three occasions, in randomised order, receiving 200-ml preloads of either water, fat (30 ml olive oil) or whey protein (55 g), 30 min before a mixed meal. PE, CAT, BSL, plasma 3-O-methyl-D-glucopyranose (3-OMG), insulin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1) and glucagon, blood pressure (BP), heart rate (HR) and GI symptoms were assessed over 270 min. RESULTS Although fat and protein preloads did not alter PE of either solids or liquids, the CAT of solids, but not liquids, was longer than that after the water preload (fat 68 ± 5 min and protein 71 ± 6 min vs. water 46 ± 5 min; P = 0.02). BSL elevated promptly after the meal on all days (P < 0.001), but after protein, the magnitude and integrated increases in the first 75 min were less than fat and water preloads (area under the curve (AUC(0-75 min)), 18.7 ± 18.2 vs. 107.2 ± 30.4 and 76.1 ± 19.3 mmol/L/min; P < 0.05). Compared to water preload, the protein and fat preloads were associated with greater increases in plasma insulin, GLP-1 and glucagon concentrations, a reduction in BP, and greater increases in HR, fullness, bloating and nausea. Plasma 3-OMG levels were lower after the protein than after the water and fat preloads (P < 0.001). CONCLUSIONS Given its effects to attenuate post-prandial glycaemia, reduce intestinal glucose absorption and potentiate the "incretin response", without inducing more adverse post-prandial GI symptom, protein preload may prove clinically useful in RYGB patients and warrant further evaluation, particularly in those with type 2 diabetes (T2DM) and/or dumping syndrome.
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Affiliation(s)
- Nam Q Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Tamara L Debreceni
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | - Carly M Burgstad
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | - Melissa Neo
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | - Max Bellon
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Judith M Wishart
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Scott Standfield
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Dylan Bartholomeusz
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Chris K Rayner
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Gary Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
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