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Sun X, Deng Y, Fang L, Ni M, Wang X, Zhang T, Chen Y, Cai G, Pan F. Association of Exposure to Heavy Metal Mixtures with Systemic Immune-Inflammation Index Among US Adults in NHANES 2011-2016. Biol Trace Elem Res 2024; 202:3005-3017. [PMID: 37817047 DOI: 10.1007/s12011-023-03901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023]
Abstract
In reality, people are often co-exposed to multiple heavy metals; however, current research has focused on the association between individual heavy metals and inflammation. Therefore, it is more relevant to explore the combined effects of multiple heavy metal exposure on inflammation. The study included data from the National Health and Nutrition Examination Survey (NHANES), 2011-2016. The systemic immune-inflammation index (SII) was used to reflect systemic immune-inflammation status. In this study, single variable models were used to assess the linear and non-linear relationships between single heavy metal exposures and SII. To analyze the combined effect of mixed heavy metals exposure on SII, we constructed three statistical models, including weighted quantile sum (WQS) regression, quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR). The single-exposure analysis found positive associations between multiple heavy metals and SII, while mercury in blood was negatively associated with SII, and U-shaped correlations were observed between blood lead, urine barium and strontium, and SII. In the WQS model, SII increased significantly with increasing concentrations of mixed heavy metals, while consistent results in the qgcomp model, but not statistically significant. In the BKMR model, exposure to heavy metal mixtures was positively associated with SII, with mercury, cadmium, and cobalt in urine contributing the most to the mixed exposure. In addition, synergistic and antagonistic effects between heavy metals on increasing SII were found in our study. In summary, our results reveal that combined exposure to multiple heavy metals is positively associated with SII in the US adults.
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Affiliation(s)
- Xiaoya Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yujie Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Lanlan Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Man Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xinqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yuting Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China.
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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Wiebe N, Tonelli M. Long-term clinical outcomes of bariatric surgery in adults with severe obesity: A population-based retrospective cohort study. PLoS One 2024; 19:e0298402. [PMID: 38843138 PMCID: PMC11156280 DOI: 10.1371/journal.pone.0298402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/25/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Bariatric surgery leads to sustained weight loss in a majority of recipients, and also reduces fasting insulin levels and markers of inflammation. We described the long-term associations between bariatric surgery and clinical outcomes including 30 morbidities. METHODS We did a retrospective population-based cohort study of 304,157 adults with severe obesity, living in Alberta, Canada; 6,212 of whom had bariatric surgery. We modelled adjusted time to mortality, hospitalization, surgery and the adjusted incidence/prevalence of 30 new or ongoing morbidities after 5 years of follow-up. RESULTS Over a median follow-up of 4.4 years (range 1 day-22.0 years), bariatric surgery was associated with increased risk of hospitalization (HR 1.46, 95% CI 1.41,1.51) and additional surgery (HR 1.42, 95% CI 1.32,1.52) but with a decreased risk of mortality (HR 0.76, 95% CI 0.64,0.91). After 5 years (median of 9.9 years), bariatric surgery was associated with a lower risk of severe chronic kidney disease (HR 0.45, 95% CI 0.27,0.75), coronary disease (HR 0.49, 95% CI 0.33,0.72), diabetes (HR 0.51, 95% CI 0.47,0.56), inflammatory bowel disease (HR 0.55, 95% CI 0.37,0.83), hypertension (HR 0.70, 95% CI 0.66,0.75), chronic pulmonary disease (HR 0.75, 95% CI 0.66,0.86), asthma (HR 0.79, 95% 0.65,0.96), cancer (HR 0.79, 95% CI 0.65,0.96), and chronic heart failure (HR 0.79, 95% CI 0.64,0.96). In contrast, after 5 years, bariatric surgery was associated with an increased risk of peptic ulcer (HR 1.99, 95% CI 1.32,3.01), alcohol misuse (HR 1.55, 95% CI 1.25,1.94), frailty (HR 1.28, 95% 1.11,1.46), severe constipation (HR 1.26, 95% CI 1.07,1.49), sleep disturbance (HR 1.21, 95% CI 1.08,1.35), depression (HR 1.18, 95% CI 1.10,1.27), and chronic pain (HR 1.12, 95% CI 1.04,1.20). INTERPRETATION Bariatric surgery was associated with lower risks of death and certain morbidities. However, bariatric surgery was also associated with increased risk of hospitalization and additional surgery, as well as certain other morbidities. Since values and preferences for these various benefits and harms may differ between individuals, this suggests that comprehensive counselling should be offered to patients considering bariatric surgery.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Wiebe N, Lloyd A, Crumley ET, Tonelli M. Associations between body mass index and all-cause mortality: A systematic review and meta-analysis. Obes Rev 2023; 24:e13588. [PMID: 37309266 DOI: 10.1111/obr.13588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Fasting insulin and c-reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the "average" associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non-first order polynomials or splines. All-cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2 . Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β -0.829 [95% CI -1.313, -0.345] and adjusted β -0.746 [95% CI -1.471, -0.021]), Covid-19 (unadjusted β -0.333 [95% CI -0.650, -0.015]), critically ill (adjusted β -0.550 [95% CI -1.091, -0.010]), and surgical (unadjusted β -0.415 [95% CI -0.824, -0.006]) populations. The associations for general, cancer, and non-communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re-examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ellen T Crumley
- Rowe School of Business, Dalhousie University, Halifax, Nova Scotia, Canada
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Chen H, Feng Y, Chen C, Yu S. Both early and late maternal age at childbirth is associated with increasing odds of central obesity in offspring. Am J Hum Biol 2023; 35:e23898. [PMID: 36932653 DOI: 10.1002/ajhb.23898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE Despite studies on offspring obesity and delayed parenthood, little attention has been paid to the central obesity of offspring. The purpose of this study was to test the hypothesis that maternal age at childbirth (MAC) was associated with central obesity in offspring among the adult population, and fasting insulin may play a role in this association as a mediating factor. METHODS A total of 423 adults (mean age 37.9 years, 37.1% female) were included. Information about maternal variables and other confounders was collected by face-to-face interview. Waist circumference and insulin were determined through physical measurements and biochemical examinations. Logistic regression model and restricted cubic spline model were used to analyze the relationship between MAC and central obesity of offspring. The mediating effect of fasting insulin levels on association between MAC and offspring waist circumference was also analyzed. RESULTS There was a nonlinear relationship between MAC and central obesity in offspring. Compared with subjects with MAC 27-32 years, those with MAC 21-26 years (OR = 1.814, 95% CI: 1.129-2.915) and MAC ≥33 years (OR = 3.337, 95% CI: 1.638-6.798) had higher odds to develop central obesity. Offspring fasting insulin was also higher in MAC 21-26 years and MAC ≥33 years compared with those with MAC 27-32 years. Taking the group MAC 27-32 years as reference, the mediating effect of fasting insulin levels on the waist circumference was 20.6% and 12.4% for MAC 21-26 years and ≥ 33 years, respectively. CONCLUSION MAC 27-32 years has the lowest odds of central obesity in offspring. Fasting insulin levels may have a partial mediating effect on the association between MAC and central obesity.
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Affiliation(s)
- Hongyun Chen
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yinhua Feng
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Changying Chen
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Academic Training Center, Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Songcheng Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Academic Training Center, Institute for Hospital Management of Henan Province, Zhengzhou, China
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Muñoz VR, Botezelli JD, Gaspar RC, da Rocha AL, Vieira RFL, Crisol BM, Braga RR, Severino MB, Nakandakari SCBR, Antunes GC, Brunetto SQ, Ramos CD, Velloso LA, Simabuco FM, de Moura LP, da Silva ASR, Ropelle ER, Cintra DE, Pauli JR. Effects of short-term endurance and strength exercise in the molecular regulation of skeletal muscle in hyperinsulinemic and hyperglycemic Slc2a4 +/- mice. Cell Mol Life Sci 2023; 80:122. [PMID: 37052684 PMCID: PMC11072257 DOI: 10.1007/s00018-023-04771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Intriguingly, hyperinsulinemia, and hyperglycemia can predispose insulin resistance, obesity, and type 2 diabetes, leading to metabolic disturbances. Conversely, physical exercise stimulates skeletal muscle glucose uptake, improving whole-body glucose homeostasis. Therefore, we investigated the impact of short-term physical activity in a mouse model (Slc2a4+/-) that spontaneously develops hyperinsulinemia and hyperglycemia even when fed on a chow diet. METHODS Slc2a4+/- mice were used, that performed 5 days of endurance or strength exercise training. Further analysis included physiological tests (GTT and ITT), skeletal muscle glucose uptake, skeletal muscle RNA-sequencing, mitochondrial function, and experiments with C2C12 cell line. RESULTS When Slc2a4+/- mice were submitted to the endurance or strength training protocol, improvements were observed in the skeletal muscle glucose uptake and glucose metabolism, associated with broad transcriptomic modulation, that was, in part, related to mitochondrial adaptations. The endurance training, but not the strength protocol, was effective in improving skeletal muscle mitochondrial activity and unfolded protein response markers (UPRmt). Moreover, experiments with C2C12 cells indicated that insulin or glucose levels could contribute to these mitochondrial adaptations in skeletal muscle. CONCLUSIONS Both short-term exercise protocols were efficient in whole-body glucose homeostasis and insulin resistance. While endurance exercise plays an important role in transcriptome and mitochondrial activity, strength exercise mostly affects post-translational mechanisms and protein synthesis in skeletal muscle. Thus, the performance of both types of physical exercise proved to be a very effective way to mitigate the impacts of hyperglycemia and hyperinsulinemia in the Slc2a4+/- mouse model.
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Affiliation(s)
- Vitor Rosetto Muñoz
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil.
| | - José Diego Botezelli
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Rafael Calais Gaspar
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Alisson L da Rocha
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Renan Fudoli Lins Vieira
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Barbara Moreira Crisol
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Renata Rosseto Braga
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Matheus Brandemarte Severino
- Multidisciplinary Laboratory of Food and Health (LabMAS), School of Applied Sciences (FCA), University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | | | - Gabriel Calheiros Antunes
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Sérgio Q Brunetto
- Biomedical Engineering Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Celso D Ramos
- Biomedical Engineering Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Department of Radiology, University of Campinas, Campinas, São Paulo, 13084-970, Brazil
| | - Lício Augusto Velloso
- OCRC - Obesity and Comorbidities Research Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Laboratory of Cell Signaling, Department of Internal Medicine, University of Campinas, Campinas, São Paulo, 13084-970, Brazil
| | - Fernando Moreira Simabuco
- Multidisciplinary Laboratory of Food and Health (LabMAS), School of Applied Sciences (FCA), University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
| | - Leandro Pereira de Moura
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
- OCRC - Obesity and Comorbidities Research Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Adelino Sanchez Ramos da Silva
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão, Preto Medical School, University of São Paulo (USP), School of Physical Education and Sport of Ribeirão Preto , Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Rochete Ropelle
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil
- OCRC - Obesity and Comorbidities Research Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- National Institute of Science and Technology of Obesity and Diabetes, University of Campinas (UNICAMP), Campinas , São Paulo, Brazil
| | - Dennys Esper Cintra
- Laboratory of Nutritional Genomics, University of Campinas (UNICAMP), Limeira,, São Paulo, Brazil
- OCRC - Obesity and Comorbidities Research Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - José Rodrigo Pauli
- Laboratory of Molecular Biology of Exercise, University of Campinas (UNICAMP), Limeira, São Paulo, Brazil.
- OCRC - Obesity and Comorbidities Research Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
- National Institute of Science and Technology of Obesity and Diabetes, University of Campinas (UNICAMP), Campinas , São Paulo, Brazil.
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Saleem N, Elahi S, Rizvi NB. Association of vitamin D deficiency and insulin resistance in nondiabetic obese women: role of parathyroid hormone. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-022-01164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Exploratory Longitudinal Analysis of the Circulating CHIT1 Activity in Pediatric Patients with Obesity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010124. [PMID: 36670674 PMCID: PMC9857224 DOI: 10.3390/children10010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Macrophage activation and cytokine release play a pivotal role in inflammation-mediated metabolic disturbances in obesity. The proinflammatory macrophage secretes human chitotriosidase (CHIT1). The expression of the CHIT1 in visceral adipose tissue is associated with cytokine production. Our study aimed to assess whether the CHIT1 circulating activity, as a macrophage activation indicator, reflects the change of the adiposity level and the insulin resistance (IR) in children with obesity. We longitudinally (median follow-up period of 7 months; IQR [5 to 8.5] and {2 to 13} months) evaluated the CHIT1 circulating activity, the adiposity level (waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WtHR), and body mass index (BMI)-for-age z score), and two surrogate markers of IR (Homeostatic Model Assessment for Insulin Resistance, HOMA-IR and the triglycerides-to-high density lipoprotein cholesterol ratio, TG/HDLc) in 29 pediatric patients (16 girls and 13 boys) with obesity. We found a significant reduction in CHIT1 circulating activity (Wilcoxon test, p = 0.015) and a decrease in TG/HDLc at the follow-up evaluation (Wilcoxon test, p < 0.001). Indicators of adiposity were positively correlated with HOMA-IR at baseline, among which WC was the sole indicator associated with HOMA-IR (Spearman’s rank correlation coefficients, p < 0.05) at follow-up. Human chitotriosidase has the potential to be a valuable measure of the progression of subclinical inflammation in children with obesity. Subclinical inflammation, as expressed by the circulating CHIT1 activity, progresses independently of the abdominal adiposity, as measured by the clinical indicators, and is associated with a change in insulin resistance.
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Wu H, Zhang Y, Wei J, Bovet P, Zhao M, Liu W, Xi B. Association between short-term exposure to ambient PM 1 and PM 2.5 and forced vital capacity in Chinese children and adolescents. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:71665-71675. [PMID: 35604593 DOI: 10.1007/s11356-022-20842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/11/2022] [Indexed: 05/17/2023]
Abstract
This study aims to examine the association between short-term exposure to ambient PM1, PM1-2.5, and PM2.5 and forced vital capacity (FVC). Population data were obtained from a school-based cross-sectional survey in Shandong in 2014. Distributed lag non-linear models were used to examine the association between exposure to PM1, PM1-2.5, and PM2.5 and FVC at the day of FVC measurement and the previous 6 days (lag 0 to 6 days). A total of 35,334 students aged 9 to 18 years were included in the study, and the mean exposure concentrations of ambient PM1, PM1-2.5, and PM2.5 for them were 47.4 (standard deviation [SD] = 21.3) μg/m3, 32.8 (SD = 32.2) μg/m3, and 80.1 (SD = 47.7) μg/m3, respectively. An inter-quartile range (IQR, 24 μg/m3) increment in exposure to PM1 was significantly associated with a lower FVC at lag 0 and lag 1 day (β = - 80 mL, 95% CI = - 119, - 42, and β = - 37 mL, 95% CI = - 59, - 16, respectively), and an IQR (54 μg/m3) increment in exposure to PM2.5 was significantly associated with a lower FVC at lag 0 and lag 1 day (β = - 57 mL, 95% CI = - 89, - 18, and β = - 34 mL, 95% CI = - 56, - 12, respectively) after adjustment for gender, age, body mass index category, residence, month of the survey, intake of eggs, intake of milk, physical activity, and screen time. No significant associations were observed for PM1-2.5. The inverse associations of PM1 and PM2.5 with FVC were larger in males, younger children, those overweight or obese, and those with insufficient physical activity levels. Short-term exposure to ambient PM1 and PM2.5 was associated with decreased FVC, and PM1 may be the primary fraction of PM2.5 causing the adverse pulmonary effects. Our findings emphasize the need to address ambient PM, especially PM1, pollution for affecting pulmonary health in children and adolescents.
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Affiliation(s)
- Han Wu
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yingxiu Zhang
- Shandong Center for Disease Control and Prevention, Shandong University Institute of Preventive Medicine, Jinan, Shandong, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Pascal Bovet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wenhui Liu
- Information and Data Analysis Lab, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Davis JN, Williams A, Arnold CD, Rohner F, Wirth JP, Addo Y, Flores-Ayala RC, Oaks BM, Young MF, Suchdev PS, Engle-Stone R. The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis. Curr Dev Nutr 2022; 6:nzac139. [PMID: 36475018 PMCID: PMC9718651 DOI: 10.1093/cdn/nzac139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 10/03/2023] Open
Abstract
Background In the presence of inflammation, the serum or plasma ferritin concentration ("ferritin" hereafter) transiently increases, confounding its interpretation as an iron status marker. The extent to which adiposity-related inflammation may influence ferritin interpretation is uncertain. Objectives We describe relationships between weight status, inflammation, and ferritin among nonpregnant women of reproductive age (WRA; 15-49 years) and preschool-age children (PSC; 6-59 months) with normal weight to overweight or obesity (OWOB) in differing geographic settings. Methods Cross-sectional data were separately analyzed from 18 surveys (WRA) and 25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (in WRA) or BMI-for-age z-score (BAZ; in PSC), inflammatory biomarkers of C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP), ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs. Results were grouped by World Bank income classifications. Results In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully, in the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. Conclusions Where having OWOB is common among WRA, measurements of inflammatory biomarkers and their uses in interpreting ferritin may improve iron status assessments. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status. Included Kenyan trial data are registered at clinicaltrials.gov as NCT01088958.
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Affiliation(s)
- Jennie N Davis
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | - Anne Williams
- University of Otago, Department of Human Nutrition, Dunedin, New Zealand
| | - Charles D Arnold
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | | | | | - Yaw Addo
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Melissa F Young
- Global Health Department, Emory University, Atlanta, GA, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reina Engle-Stone
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
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Griauzde DH, O'Brien A, Yancy WS, Richardson CR, Krinock J, DeJonckheere M, Isaman DJM, Vanias K, Shopinski S, Saslow LR. Testing a very low-carbohydrate adaption of the Diabetes Prevention Program among adults with prediabetes: study protocol for the Lifestyle Education about prediabetes (LEAP) trial. Trials 2022; 23:827. [PMID: 36176003 PMCID: PMC9524018 DOI: 10.1186/s13063-022-06770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Center for Disease Control and Prevention's National Diabetes Prevention Program (NDPP) aims to help individuals with prediabetes avoid progression to type 2 diabetes mellitus (T2DM) through weight loss. Specifically, the NDPP teaches individuals to follow a low-fat, calorie-restricted diet and to engage in regular physical activity to achieve ≥ 5% body weight loss. Most NDPP participants, however, do not achieve this weight loss goal, and glycemic control remains largely unchanged. One promising opportunity to augment the NDPP's weight loss and glycemic effectiveness may be to teach participants to follow a very low-carbohydrate diet (VLCD), which can directly reduce post-prandial glycemia and facilitate weight loss by reducing circulating insulin and enabling lipolysis. To date, there have been no high-quality, randomized controlled trials to test whether a VLCD can prevent progression to T2DM among individuals with prediabetes. The aim of this study is to test the effectiveness of a VLCD version the NDPP (VLC-NDPP) versus the standard NDPP. We hypothesize the VLC-NDPP will demonstrate greater improvements in weight loss and glycemic control. METHODS We propose to conduct a 12-month, 1:1, randomized controlled trial that will assign 300 adults with overweight or obesity and prediabetes to either the NDPP or VLC-NDPP. The primary outcome will be glycemic control as measured by change in hemoglobin A1c (HbA1c) from baseline to 12 months. Secondary outcomes will include percent body weight change and changes in glycemic variability, inflammatory markers, lipids, and interim HbA1c. We will evaluate progression to T2DM and initiation of anti-hyperglycemic agents. We will conduct qualitative interviews among a purposive sample of participants to explore barriers to and facilitators of dietary adherence. The principal quantitative analysis will be intent-to-treat using hierarchical linear mixed effects models to assess differences over time. DISCUSSION The NDPP is the dominant public health strategy for T2DM prevention. Changing the program's dietary advice to include a carbohydrate-restricted eating pattern as an alternative option may enhance the program's effectiveness. If the VLC-NDPP shows promise, this trial would be a precursor to a multi-site trial with incident T2DM as the primary outcome. TRIAL REGISTRATION NCT05235425. Registered February 11, 2022.
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Affiliation(s)
- Dina H Griauzde
- Department of Internal Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 16-371C, Ann Arbor, MI, 48109-2800, USA. .,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
| | - Alison O'Brien
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caroline R Richardson
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jamie Krinock
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deanna J M Isaman
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Kaitlyn Vanias
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | | | - Laura R Saslow
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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11
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Aflatounian A, Paris VR, Richani D, Edwards MC, Cochran BJ, Ledger WL, Gilchrist RB, Bertoldo MJ, Wu LE, Walters KA. Declining muscle NAD + in a hyperandrogenism PCOS mouse model: Possible role in metabolic dysregulation. Mol Metab 2022; 65:101583. [PMID: 36096453 PMCID: PMC9490589 DOI: 10.1016/j.molmet.2022.101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/12/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder, defined by reproductive and endocrine abnormalities, with metabolic dysregulation including obesity, insulin resistance and hepatic steatosis. Recently, it was found that skeletal muscle insulin sensitivity could be improved in obese, post-menopausal, pre-diabetic women through treatment with nicotinamide mononucleotide (NMN), a precursor to the prominent redox cofactor nicotinamide adenine dinucleotide (NAD+). Given that PCOS patients have a similar endocrine profile to these patients, we hypothesised that declining NAD levels in muscle might play a role in the pathogenesis of the metabolic syndrome associated with PCOS, and that this could be normalized through NMN treatment. Here, we tested the impact of NMN treatment on the metabolic syndrome of the dihydrotestosterone (DHT) induced mouse model of PCOS. We observed lower NAD levels in the muscle of PCOS mice, which was normalized by NMN treatment. PCOS mice were hyperinsulinaemic, resulting in increased adiposity and hepatic lipid deposition. Strikingly, NMN treatment completely normalized these aspects of metabolic dysfunction. We propose that addressing the decline in skeletal muscle NAD levels associated with PCOS can normalize insulin sensitivity, preventing compensatory hyperinsulinaemia, which drives obesity and hepatic lipid deposition, though we cannot discount an impact of NMN on other tissues to mediate these effects. These findings support further investigation into NMN treatment as a new therapy for normalizing the aberrant metabolic features of PCOS. Polycystic ovarian syndrome (PCOS) leads to declining NAD+ levels in skeletal muscle tissue. Declining NAD+ in muscle can be rescued by treating with the metabolic precursor nicotinamide mononucleotide (NMN). NMN treatment corrects compensatory hyperinsulinemia in a mouse model of PCOS. Reductions in circulating insulin levels from NMN treatment moderates adipose expansion and hepatic lipid deposition.
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Affiliation(s)
- Ali Aflatounian
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Valentina Rodriguez Paris
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Dulama Richani
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Melissa C Edwards
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Blake J Cochran
- School of Medical Sciences, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - William L Ledger
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Robert B Gilchrist
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Michael J Bertoldo
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia; School of Medical Sciences, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Lindsay E Wu
- School of Medical Sciences, University of New South Wales Sydney, Sydney, NSW 2052, Australia.
| | - Kirsty A Walters
- Fertility and Research Centre, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
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12
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Wiebe N, Muntner P, Tonelli M. Associations of body mass index, fasting insulin, and inflammation with mortality: a prospective cohort study. Int J Obes (Lond) 2022; 46:2107-2113. [PMID: 36030344 DOI: 10.1038/s41366-022-01211-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity is often considered to increase the risk for premature mortality. Higher fasting insulin and c-reactive protein are associated with higher body mass index (BMI) and all-cause mortality, so may confound the association between obesity and mortality. Our objective was to determine the independent associations between BMI, fasting insulin, c-reactive protein, and all-cause mortality in a general population sample. METHODS This prospective cohort study included non-institutionalized US adults (≥20 years) from the National Health and Nutrition Examination Surveys 1999-2000 to 2013-2014. The main exposures of interest were BMI, fasting insulin, c-reactive protein. Mortality data were obtained through linking participants to the National Death Index (ending December 31, 2015). RESULTS There were 12,563 participants with a median age of 45 years (range 20-85) and 47.9% were male. The median BMI was 27 kg/m2 (IQR 24-32), median fasting insulin was 54 pmol/L (IQR 35-87), and median c-reactive protein was 1.9 mg/L (IQR 0.8-4.4). In a Cox model adjusted for age, biological sex, cigarette smoking, and ten chronic conditions, higher BMI parameterized with quadratic and linear terms was not associated with mortality. When fasting insulin and the natural logarithm of c-reactive protein were included in the model, an inverse association between BMI and mortality was present (compared to the referent category of 5th percentile: 1st percentile, HR 1.10, 95% CI 1.06-1.13; 99th percentile, HR 0.48, 95% CI 0.34-0.69). In contrast, higher levels of fasting insulin and c-reactive protein were associated with an increased risk of mortality (for fasting insulin: 1st percentile, HR 0.98, 95% CI 0.97-0.99; 99th percentile, HR 1.83, 95% CI 1.48-2.26; for c-reactive protein, 1st percentile, HR 0.87, 95% CI 0.84-0.90; 99th percentile, HR 2.77, 95% CI 2.12-3.62). CONCLUSIONS Higher fasting insulin and higher c-reactive protein confound the association between BMI and the risk of all-cause mortality. The increase in mortality that has been attributed to higher BMI is more likely due to hyperinsulinemia and inflammation rather than obesity.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Paul Muntner
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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13
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Siqueira CHIA, Esteves LG, Duarte CK. Plant-based diet index score is not associated with body composition: a systematic review and meta-analysis. Nutr Res 2022; 104:128-139. [DOI: 10.1016/j.nutres.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022]
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14
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Chauhan H, Belski R, Bryant E, Cooke M. Dietary Assessment Tools and Metabolic Syndrome: Is It Time to Change the Focus? Nutrients 2022; 14:nu14081557. [PMID: 35458121 PMCID: PMC9032662 DOI: 10.3390/nu14081557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/16/2022] Open
Abstract
Metabolic syndrome (MS) is associated with a range of chronic diseases, for which lifestyle interventions are considered the cornerstone of treatment. Dietary interventions have primarily focused on weight reduction, usually via energy restricted diets. While this strategy can improve insulin sensitivity and other health markers, weight loss alone is not always effective in addressing all risk factors associated with MS. Previous studies have identified diet quality as a key factor in reducing the risk of MS independent of weight loss. Additionally, supporting evidence for the use of novel strategies such as carbohydrate restriction and modifying the frequency and timing of meals is growing. It is well established that dietary assessment tools capable of identifying dietary patterns known to increase the risk of MS are essential for the development of personalised, targeted diet and lifestyle advice. The American Heart Association (AHA) recently evaluated the latest in a variety of assessment tools, recommending three that demonstrate the highest evidence-based and clinical relevance. However, such tools may not assess and thus identify all dietary and eating patterns associated with MS development and treatment, especially those which are new and emerging. This paper offers a review of current dietary assessment tools recommended for use by the AHA to assess dietary and eating patterns associated with MS development. We discuss how these recommendations align with recent and novel evidence on the benefits of restricting ultra-processed food and refined carbohydrates and modifying timing and frequency of meals. Finally, we provide recommendations for future redevelopment of these tools to be deployed in health care settings.
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Affiliation(s)
- Helen Chauhan
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (H.C.); (R.B.)
| | - Regina Belski
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (H.C.); (R.B.)
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Eleanor Bryant
- Division of Psychology, University of Bradford, Bradford BD7 1DP, UK;
| | - Matthew Cooke
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (H.C.); (R.B.)
- Correspondence:
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15
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Cen HH, Hussein B, Botezelli JD, Wang S, Zhang JA, Noursadeghi N, Jessen N, Rodrigues B, Timmons JA, Johnson JD. Human and mouse muscle transcriptomic analyses identify insulin receptor mRNA downregulation in hyperinsulinemia-associated insulin resistance. FASEB J 2022; 36:e22088. [PMID: 34921686 PMCID: PMC9255858 DOI: 10.1096/fj.202100497rr] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
Hyperinsulinemia is commonly viewed as a compensatory response to insulin resistance, yet studies have demonstrated that chronically elevated insulin may also drive insulin resistance. The molecular mechanisms underpinning this potentially cyclic process remain poorly defined, especially on a transcriptome-wide level. Transcriptomic meta-analysis in >450 human samples demonstrated that fasting insulin reliably and negatively correlated with INSR mRNA in skeletal muscle. To establish causality and study the direct effects of prolonged exposure to excess insulin in muscle cells, we incubated C2C12 myotubes with elevated insulin for 16 h, followed by 6 h of serum starvation, and established that acute AKT and ERK signaling were attenuated in this model of in vitro hyperinsulinemia. Global RNA-sequencing of cells both before and after nutrient withdrawal highlighted genes in the insulin receptor (INSR) signaling, FOXO signaling, and glucose metabolism pathways indicative of 'hyperinsulinemia' and 'starvation' programs. Consistently, we observed that hyperinsulinemia led to a substantial reduction in Insr gene expression, and subsequently a reduced surface INSR and total INSR protein, both in vitro and in vivo. Bioinformatic modeling combined with RNAi identified SIN3A as a negative regulator of Insr mRNA (and JUND, MAX, and MXI as positive regulators of Irs2 mRNA). Together, our analysis identifies mechanisms which may explain the cyclic processes underlying hyperinsulinemia-induced insulin resistance in muscle, a process directly relevant to the etiology and disease progression of type 2 diabetes.
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Affiliation(s)
- Haoning Howard Cen
- Department of Cellular and Physiological Sciences, Life Science Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bahira Hussein
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - José Diego Botezelli
- Department of Cellular and Physiological Sciences, Life Science Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Su Wang
- Department of Cellular and Physiological Sciences, Life Science Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jiashuo Aaron Zhang
- Department of Cellular and Physiological Sciences, Life Science Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nilou Noursadeghi
- Department of Cellular and Physiological Sciences, Life Science Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Niels Jessen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Rodrigues
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A Timmons
- Augur Precision Medicine LTD, Stirling University Innovation Park, Stirling, Scotland.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - James D Johnson
- Department of Cellular and Physiological Sciences, Life Science Institute, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Prevalence of Vitamin D Deficiency and Its Association with Insulin Resistance in Obese Women with Normal Fasting Glucose. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2259711. [PMID: 34950730 PMCID: PMC8691995 DOI: 10.1155/2021/2259711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022]
Abstract
Results A total of 264 obese and 133 normal BMI women (controls) of age range 20-50 years were selected. Obese women had significantly lower vitamin D compared to control women (P < 0.05). Among euglycemic (fasting glucose < 100 mg/dl) obese women (n = 221), 90 (40.7%) were vitamin D deficient. Serum PTH and calcium levels were negatively correlated, though nonsignificantly with vitamin D (r = −0.172, P = 0.090, and r = −0.051, P = 0.557, respectively). The mean age, BMI, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), fasting glucose, fasting insulin, PTH, and calcium were not significantly different in vitamin D-deficient as compared to nondeficient obese women. IR was detected in 109 (49.3%) obese women. Mean HOMA-IR in vitamin D-deficient women was significantly higher than that in the nondeficient obese women (3.03 ± 1.64 vs. 2.40 ± 1.02; P = 0.041), but the percentage of women with IR was comparable in both groups (51.1% vs. 45.8%; P = 0.745). Univariate analysis revealed that HOMA-IR was negatively correlated with vitamin D and positively with BMI and PTH. A multivariate regression analysis, stepwise method revealed that BMI and PTH were independent determinants of HOMA-IR instead of vitamin D. Conclusion More than 40% of obese women were vitamin D deficient. Among euglycemic obese women, 49% were insulin resistant. Prevalence of insulin resistance, though negatively correlated with vitamin D, could be better explained by BMI and PTH levels.
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17
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Ciaffi J, Mitselman D, Mancarella L, Brusi V, Lisi L, Ruscitti P, Cipriani P, Meliconi R, Giacomelli R, Borghi C, Ursini F. The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review. Front Med (Lausanne) 2021; 8:792846. [PMID: 34970568 PMCID: PMC8712653 DOI: 10.3389/fmed.2021.792846] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023] Open
Abstract
The principle of ketogenic diet (KD) is restriction of carbohydrates to a maximum of 5-10% of the total daily caloric intake, aiming at shifting body metabolism toward ketone bodies. Different studies suggested promising results of KD to help patients to lose weight, to reduce insulin requirements in diabetes, to supplement cancer protocols, to treat neurological conditions and to optimize control of metabolic and cardiovascular diseases. However, literature about the anti-inflammatory properties of KD in rheumatic diseases is still limited. The beneficial effects of weight loss in patients with inflammatory arthritis can be explained by biomechanical and biochemical factors. Obesity is associated with macrophage activation and production of pro-inflammatory cytokines including TNF-α, IL-1b, and IL-6. The clinical effect of KD may be primarily attributed to improvement of insulin sensitivity. Insulin resistance is associated with an increase of TNF-α, IL-1α, IL-1β, IL-6, and leptin. Moreover, reduction of body's adipose tissue and weight loss account for part of the anti-inflammatory effects and for the impact of KD on cardiovascular health. In rheumatoid arthritis, fasting was shown to be effective in reducing disease symptoms, possibly through the production of β-hydroxybutyrate (BHB), the main ketone body. BHB may exert inhibitory effects also on IL-17 and intermittent fasting improved the clinical manifestations of psoriatic arthritis. In ankylosing spondylitis, current literature doesn't allow to draw conclusion about the effects of KD. Future prospective studies will be needed to elucidate the potential beneficial effects of KD on specific domains and clinical outcomes in patients with inflammatory arthritis.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Dmitri Mitselman
- Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) S.Orsola, University of Bologna, Bologna, Italy
| | - Luana Mancarella
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Brusi
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Lisi
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Riccardo Meliconi
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Roberto Giacomelli
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) S.Orsola, University of Bologna, Bologna, Italy
| | - Francesco Ursini
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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18
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Brain K, Burrows TL, Bruggink L, Malfliet A, Hayes C, Hodson FJ, Collins CE. Diet and Chronic Non-Cancer Pain: The State of the Art and Future Directions. J Clin Med 2021; 10:5203. [PMID: 34768723 PMCID: PMC8584994 DOI: 10.3390/jcm10215203] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 12/28/2022] Open
Abstract
Nutrition plays an important role in pain management. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and associated comorbidities. The role of nutrition in chronic non-cancer pain management is an emerging field with increasing interest from clinicians and patients. Evidence from a number of recent systematic reviews shows that optimising diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long chain and monounsaturated fats, antioxidants, and fibre leads to reduction in pain severity and interference. This review describes the current state of the art and highlights why nutrition is critical within a person-centred approach to pain management. Recommendations are made to guide clinicians and highlight areas for future research.
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Affiliation(s)
- Katherine Brain
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.B.); (T.L.B.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Tracy L. Burrows
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.B.); (T.L.B.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Laura Bruggink
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Anneleen Malfliet
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
- Pain in Motion International Research Group, 1000 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Chris Hayes
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Fiona J. Hodson
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Clare E. Collins
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.B.); (T.L.B.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
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19
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Kawamura R, Tabara Y, Takata Y, Maruyama K, Takakado M, Hadate T, Matsushita Y, Sano M, Makino H, Saito I, Kanatsuka A, Osawa H. Association of a SNP in the IAPP gene and hyperglycemia on β-cell dysfunction in type 2 diabetes: the Toon Genome Study. Diabetol Int 2021; 13:201-208. [DOI: 10.1007/s13340-021-00523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
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20
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Venniyoor A, Al Farsi AA, Al Bahrani B. The Troubling Link Between Non-alcoholic Fatty Liver Disease (NAFLD) and Extrahepatic Cancers (EHC). Cureus 2021; 13:e17320. [PMID: 34557366 PMCID: PMC8449927 DOI: 10.7759/cureus.17320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a fast-spreading epidemic across the globe and has serious implications far beyond that of a "benign" liver condition. It is usually an outcome of ectopic fat storage due to chronic positive energy balance leading to obesity and is associated with multiple health problems. While association with cardiovascular disease and hepatocellular cancer is well recognized, it is becoming clear the NAFLD carries with it an increased risk of cancers of extrahepatic tissues. Studies have reported a higher risk for cancers of the colon, breast, prostate, lung, and pancreas. Fatty liver is associated with increased mortality; there is an urgent need to understand that fatty liver is not always benign, and not always associated with obesity. It is, however, a reversible condition and early recognition and intervention can alter its natural history and associated complications.
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Affiliation(s)
- Ajit Venniyoor
- Medical Oncology, National Oncology Center, The Royal Hospital, Muscat, OMN
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Yong J, Johnson JD, Arvan P, Han J, Kaufman RJ. Therapeutic opportunities for pancreatic β-cell ER stress in diabetes mellitus. Nat Rev Endocrinol 2021; 17:455-467. [PMID: 34163039 PMCID: PMC8765009 DOI: 10.1038/s41574-021-00510-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus is characterized by the failure of insulin-secreting pancreatic β-cells (or β-cell death) due to either autoimmunity (type 1 diabetes mellitus) or failure to compensate for insulin resistance (type 2 diabetes mellitus; T2DM). In addition, mutations of critical genes cause monogenic diabetes. The endoplasmic reticulum (ER) is the primary site for proinsulin folding; therefore, ER proteostasis is crucial for both β-cell function and survival under physiological and pathophysiological challenges. Importantly, the ER is also the major intracellular Ca2+ storage organelle, generating Ca2+ signals that contribute to insulin secretion. ER stress is associated with the pathogenesis of diabetes mellitus. In this Review, we summarize the mutations in monogenic diabetes that play causal roles in promoting ER stress in β-cells. Furthermore, we discuss the possible mechanisms responsible for ER proteostasis imbalance with a focus on T2DM, in which both genetics and environment are considered important in promoting ER stress in β-cells. We also suggest that controlled insulin secretion from β-cells might reduce the progression of a key aspect of the metabolic syndrome, namely nonalcoholic fatty liver disease. Finally, we evaluate potential therapeutic approaches to treat T2DM, including the optimization and protection of functional β-cell mass in individuals with T2DM.
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Affiliation(s)
- Jing Yong
- Degenerative Diseases Program, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - James D Johnson
- Department of Cellular and Physiological Sciences & Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Arvan
- Division of Metabolism Endocrinology & Diabetes, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Jaeseok Han
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan-si, Choongchungnam-do, Republic of Korea.
| | - Randal J Kaufman
- Degenerative Diseases Program, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA.
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Noakes TD. Hiding unhealthy heart outcomes in a low-fat diet trial: the Women's Health Initiative Randomized Controlled Dietary Modification Trial finds that postmenopausal women with established coronary heart disease were at increased risk of an adverse outcome if they consumed a low-fat 'heart-healthy' diet. Open Heart 2021; 8:openhrt-2021-001680. [PMID: 34290045 PMCID: PMC8296783 DOI: 10.1136/openhrt-2021-001680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
The Women’s Health Initiative Randomized Controlled Dietary Modification Trial (WHIRCDMT) was designed to test whether the US Department of Agriculture’s 1977 Dietary Guidelines for Americans protects against coronary heart disease (CHD) and other chronic diseases. The only significant finding in the original 2006 WHIRCDMT publication was that postmenopausal women with CHD randomised to a low-fat ‘heart-healthy’ diet in 1993 were at 26% greater risk of developing additional CHD events compared with women with CHD eating the control diet. A 2017 WHIRCDMT publication includes data for an additional 5 years of follow-up. It finds that CHD risk in this subgroup of postmenopausal women had increased further to 47%–61%. The authors present three post-hoc rationalisations to explain why this finding is ‘inadmissible’: (1) only women in this subgroup were less likely to adhere to the prescribed dietary intervention; (2) their failure to follow the intervention diet increased their CHD risk; and (3) only these women were more likely to not have received cholesterol-lowering drugs. These rationalisations appear spurious. Rather these findings are better explained as a direct consequence of postmenopausal women with features of insulin resistance (IR) eating a low-fat high-carbohydrate diet for 13 years. All the worst clinical features of IR, including type 2 diabetes mellitus (T2DM) in some, can be ‘reversed’ by the prescription of a high-fat low-carbohydrate diet. The Women’s Health Study has recently reported that T2DM (10.71-fold increased risk) and other markers of IR including metabolic syndrome (6.09-fold increased risk) were the most powerful predictors of future CHD development in women; blood low-density lipoprotein-cholesterol concentration was a poor predictor (1.38-fold increased risk). These studies challenge the prescription of the low-fat high-carbohydrate heart-healthy diet, at least in postmenopausal women with IR, especially T2DM. According to the medical principle of ‘first do no harm’, this practice is now shown to be not evidence-based, making it scientifically unjustifiable, perhaps unethical.
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Affiliation(s)
- Timothy David Noakes
- Applied Design, Cape Peninsula University of Technology, Bellville, South Africa
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Wheatley SD, Deakin TA, Arjomandkhah NC, Hollinrake PB, Reeves TE. Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes-A Narrative Review. Front Nutr 2021; 8:687658. [PMID: 34336909 PMCID: PMC8319397 DOI: 10.3389/fnut.2021.687658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/14/2021] [Indexed: 01/02/2023] Open
Abstract
Although carbohydrate restriction is not a new approach for the management of Type 2 diabetes, interest in its safety and efficacy has increased significantly in recent years. The purpose of the current narrative review is to summarise the key relevant research and practical considerations in this area, as well as to explore some of the common concerns expressed in relation to the use of such approaches. There is a strong physiological rationale supporting the role of carbohydrate restriction for the management of Type 2 diabetes, and available evidence suggests that low carbohydrate dietary approaches (LCDs) are as effective as, or superior to, other dietary approaches for its management. Importantly, LCDs appear to be more effective than other dietary approaches for facilitating a reduction in the requirement for certain medications, which leads to their effects on other health markers being underestimated. LCDs have also been demonstrated to be an effective method for achieving remission of Type 2 diabetes for some people. The available evidence does not support concerns that LCDs increase the risk of cardiovascular disease, that such approaches increase the risk of nutrient deficiencies, or that they are more difficult to adhere to than other dietary approaches. A growing number of organisations support the use of LCDs as a suitable choice for individuals with Type 2 diabetes.
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Affiliation(s)
| | | | - Nicola C Arjomandkhah
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
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Tarantino G, Citro V, Cataldi M. Findings from Studies Are Congruent with Obesity Having a Viral Origin, but What about Obesity-Related NAFLD? Viruses 2021; 13:1285. [PMID: 34372491 PMCID: PMC8310150 DOI: 10.3390/v13071285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023] Open
Abstract
Infection has recently started receiving greater attention as an unusual causative/inducing factor of obesity. Indeed, the biological plausibility of infectobesity includes direct roles of some viruses to reprogram host metabolism toward a more lipogenic and adipogenic status. Furthermore, the probability that humans may exchange microbiota components (virome/virobiota) points out that the altered response of IFN and other cytokines, which surfaces as a central mechanism for adipogenesis and obesity-associated immune suppression, is due to the fact that gut microbiota uphold intrinsic IFN signaling. Last but not least, the adaptation of both host immune and metabolic system under persistent viral infections play a central role in these phenomena. We hereby discuss the possible link between adenovirus and obesity-related nonalcoholic fatty liver disease (NAFLD). The mechanisms of adenovirus-36 (Ad-36) involvement in hepatic steatosis/NAFLD consist in reducing leptin gene expression and insulin sensitivity, augmenting glucose uptake, activating the lipogenic and pro-inflammatory pathways in adipose tissue, and increasing the level of macrophage chemoattractant protein-1, all of these ultimately leading to chronic inflammation and altered lipid metabolism. Moreover, by reducing leptin expression and secretion Ad-36 may have in turn an obesogenic effect through increased food intake or decreased energy expenditure via altered fat metabolism. Finally, Ad-36 is involved in upregulation of cAMP, phosphatidylinositol 3-kinase, and p38 signaling pathways, downregulation of Wnt10b expression, increased expression of CCAAT/enhancer binding protein-beta, and peroxisome proliferator-activated receptor gamma 2 with consequential lipid accumulation.
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Affiliation(s)
- Giovanni Tarantino
- Department of Clinical Medicine and Surgery, “Federico II” University Medical School of Naples, 80131 Napoli, Italy
| | - Vincenzo Citro
- Department of General Medicine, “Umberto I” Hospital, Nocera Inferiore (Sa), 84014 Nocera Inferiore, Italy;
| | - Mauro Cataldi
- Section of Pharmacology, Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University of Naples, 80131 Napoli, Italy;
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