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Bonet J, Barbieri E, Santoro N, Dalla Man C. Modeling Glucose, Insulin, C-Peptide, and Lactate Interplay in Adolescents During an Oral Glucose Tolerance Test. J Diabetes Sci Technol 2024:19322968241266825. [PMID: 39076151 DOI: 10.1177/19322968241266825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Lactate is not considered just a "waste product" of anaerobic glycolysis anymore. It has been proved to play a key role in several metabolic diseases, such as in the metabolic dysfunction-associated steatotic liver disease, obesity, and diabetes. The capability of simulating glucose-insulin-lactate interaction would be useful to design and test drugs targeting lactate metabolism in such pathological conditions. Minimal models are available, which describe and quantify glucose-lactate interaction but models to simulate postprandial glucose-insulin-C-peptide-lactate time courses are missing. The aim of this study is to fill this gap. METHODS Starting from the Padova Type 2 Diabetes Simulator (T2DS), we first added a description of glucose-lactate kinetics and then created a population of 100 in silico subjects to match glucose-insulin-C-peptide-lactate data of 44 adolescents with/without obesity who underwent a standard oral glucose tolerance test (OGTT) of 75 g. RESULTS The developed model accurately predicts all molecules time courses, guaranteeing precise model parameter estimates (percent coefficient of variation [CV%] median [25th-75th percentile] = 19 [9-29]%). The generated in silico population shows good agreement with the clinical data in terms of area under the curve (AUC) (P = .6, .6, .9, .6 for glucose, insulin, C-peptide, and lactate, respectively) and parameter distributions (P > .1). CONCLUSIONS We have developed a simulator to describe glucose, insulin, C-peptide, and lactate kinetics during an OGTT, which captures the behavior of a real population of adolescents with/without obesity both in terms of average and intersubject variability. Such simulator can be used to investigate the pharmacodynamics of drugs targeting lactate metabolic pathway in various pathological conditions.
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Affiliation(s)
- Jacopo Bonet
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Emiliano Barbieri
- Section of Pediatrics, Department of Translational Sciences, University of Naples Federico II, Napoli, Italy
| | - Nicola Santoro
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
- Department of Medicine and Health Sciences, "V. Tiberio" University of Molise, Campobasso, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padova, Italy
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. A Comprehensive Youth Diabetes Epidemiological Data Set and Web Portal: Resource Development and Case Studies. JMIR Public Health Surveill 2024; 10:e53330. [PMID: 38666756 PMCID: PMC11252623 DOI: 10.2196/53330] [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: 10/05/2023] [Revised: 02/06/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus (DM) and pre-diabetes mellitus (pre-DM) has been increasing among youth in recent decades in the United States, prompting an urgent need for understanding and identifying their associated risk factors. Such efforts, however, have been hindered by the lack of easily accessible youth pre-DM/DM data. OBJECTIVE We aimed to first build a high-quality, comprehensive epidemiological data set focused on youth pre-DM/DM. Subsequently, we aimed to make these data accessible by creating a user-friendly web portal to share them and the corresponding codes. Through this, we hope to address this significant gap and facilitate youth pre-DM/DM research. METHODS Building on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we cleaned and harmonized hundreds of variables relevant to pre-DM/DM (fasting plasma glucose level ≥100 mg/dL or glycated hemoglobin ≥5.7%) for youth aged 12-19 years (N=15,149). We identified individual factors associated with pre-DM/DM risk using bivariate statistical analyses and predicted pre-DM/DM status using our Ensemble Integration (EI) framework for multidomain machine learning. We then developed a user-friendly web portal named Prediabetes/diabetes in youth Online Dashboard (POND) to share the data and codes. RESULTS We extracted 95 variables potentially relevant to pre-DM/DM risk organized into 4 domains (sociodemographic, health status, diet, and other lifestyle behaviors). The bivariate analyses identified 27 significant correlates of pre-DM/DM (P<.001, Bonferroni adjusted), including race or ethnicity, health insurance, BMI, added sugar intake, and screen time. Among these factors, 16 factors were also identified based on the EI methodology (Fisher P of overlap=7.06×106). In addition to those, the EI approach identified 11 additional predictive variables, including some known (eg, meat and fruit intake and family income) and less recognized factors (eg, number of rooms in homes). The factors identified in both analyses spanned across all 4 of the domains mentioned. These data and results, as well as other exploratory tools, can be accessed on POND. CONCLUSIONS Using NHANES data, we built one of the largest public epidemiological data sets for studying youth pre-DM/DM and identified potential risk factors using complementary analytical approaches. Our results align with the multifactorial nature of pre-DM/DM with correlates across several domains. Also, our data-sharing platform, POND, facilitates a wide range of applications to inform future youth pre-DM/DM studies.
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Laine S, Sjöros T, Garthwaite T, Honka MJ, Löyttyniemi E, Eskola O, Saarenhovi M, Kallio P, Koivumäki M, Vähä-Ypyä H, Sievänen H, Vasankari T, Hirvonen J, Laitinen K, Houttu N, Kalliokoski K, Saunavaara V, Knuuti J, Heinonen IHA. Daily standing time, dietary fiber, and intake of unsaturated fatty acids are beneficially associated with hepatic insulin sensitivity in adults with metabolic syndrome. Front Endocrinol (Lausanne) 2024; 15:1272886. [PMID: 38989003 PMCID: PMC11233550 DOI: 10.3389/fendo.2024.1272886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Background Obesity is associated with impaired glucose metabolism and hepatic insulin resistance. The aim was to investigate the associations of hepatic glucose uptake (HGU) and endogenous glucose production (EGP) to sedentary behavior (SB), physical activity (PA), cardiorespiratory fitness, dietary factors, and metabolic risk markers. Methods Forty-four adults with metabolic syndrome (mean age 58 [SD 7] years, BMI ranging from 25-40kg/; 25 females) were included. HGU was measured by positron emission tomography during the hyperinsulinemic-euglycemic clamp. EGP was calculated by subtracting the glucose infusion rate during clamp from the glucose rate of disappearance. SB and PA were measured with hip-worn accelerometers (26 [SD3] days). Fitness was assessed by maximal bicycle ergometry with respiratory gas measurements and dietary intake of nutrients by 4-day food diaries. Results HGU was not associated with fitness or any of the SB or PA measures. When adjusted for sex, age, and body fat-%, HGU was associated with whole-body insulin sensitivity (β=0.58), water-insoluble dietary fiber (β=0.29), energy percent (E%) of carbohydrates (β=-0.32), saccharose (β=-0.32), mono- and polyunsaturated fatty acids (β=0.35, β=0.41, respectively). EGP was associated with whole-body insulin sensitivity (β=-0.53), and low-density lipoprotein cholesterol [β=-0.31], and when further adjusted for accelerometry wear time, EGP was associated with standing [β=-0.43]. (p-value for all< 0.05). Conclusions Standing more, consuming a diet rich in fiber and unsaturated fatty acids, and a lower intake of carbohydrates, especially sugar, associate beneficially with hepatic insulin sensitivity. Habitual SB, PA, or fitness may not be the primary modulators of HGU and EGP. However, these associations need to be confirmed with intervention studies.
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Affiliation(s)
- Saara Laine
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Tanja Sjöros
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Taru Garthwaite
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Miikka-Juhani Honka
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | | | - Olli Eskola
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Maria Saarenhovi
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Petri Kallio
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Center, University of Turku, Turku, Finland
| | - Mikko Koivumäki
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Hirvonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kari Kalliokoski
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
- Department of Medical Physics, Division of Medical Imaging, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
| | - Ilkka H A Heinonen
- Turku PET Centre, University of Turku, Åbo Akademi University and Turku University Hospital, Turku, Finland
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Zhang Q, Xu Y, Xie L, Shu X, Zhang S, Wang Y, Wang H, Dong Q, Peng W. The function and application of edible fungal polysaccharides. ADVANCES IN APPLIED MICROBIOLOGY 2024; 127:45-142. [PMID: 38763529 DOI: 10.1016/bs.aambs.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Edible fungi, commonly known as mushrooms, are precious medicinal and edible homologous gifts from nature to us. Edible fungal polysaccharides (EFPs) are a variety of bioactive macromolecular which isolated from fruiting bodies, mycelia or fermentation broths of edible or medicinal fungus. Increasing researches have confirmed that EFPs possess multiple biological activities both in vitro and in vivo settings, including antioxidant, antiviral, anti-inflammatory, immunomodulatory, anti-tumor, hypoglycemic, hypolipidemic, and regulating intestinal flora activities. As a result, they have emerged as a prominent focus in the healthcare, pharmaceutical, and cosmetic industries. Fungal EFPs have safe, non-toxic, biodegradable, and biocompatible properties with low immunogenicity, bioadhesion ability, and antibacterial activities, presenting diverse potential applications in the food industries, cosmetic, biomedical, packaging, and new materials. Moreover, varying raw materials, extraction, purification, chemical modification methods, and culture conditions can result in variances in the structure and biological activities of EFPs. The purpose of this review is to provide comprehensively and systematically organized information on the structure, modification, biological activities, and potential applications of EFPs to support their therapeutic effects and health functions. This review provides new insights and a theoretical basis for prospective investigations and advancements in EFPs in fields such as medicine, food, and new materials.
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Affiliation(s)
- Qian Zhang
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
| | - Yingyin Xu
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
| | - Liyuan Xie
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
| | - Xueqin Shu
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
| | - Shilin Zhang
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
| | - Yong Wang
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
| | - Haixia Wang
- Horticulture Institute of Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, P.R. China.
| | - Qian Dong
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
| | - Weihong Peng
- Sichuan Institute of Edible Fungi, Chengdu, P.R. China; National-Local Joint Engineering Laboratory of Breeding and Cultivation of Edible and Medicinal Fungi, Chengdu, P.R. China; Scientifc Observing and Experimental Station of Agro-Microbial Resource and Utilization in Southwest China, Ministry of Agriculture, Chengdu, P.R. China.
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5
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Greyslak KT, Hetrick B, Bergman BC, Dean TA, Wesolowski SR, Gannon M, Schenk S, Sullivan EL, Aagaard KM, Kievit P, Chicco AJ, Friedman JE, McCurdy CE. A Maternal Western-Style Diet Impairs Skeletal Muscle Lipid Metabolism in Adolescent Japanese Macaques. Diabetes 2023; 72:1766-1780. [PMID: 37725952 PMCID: PMC10658061 DOI: 10.2337/db23-0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
Maternal consumption of a Western-style diet (mWD) during pregnancy alters fatty acid metabolism and reduces insulin sensitivity in fetal skeletal muscle. The long-term impact of these fetal adaptations and the pathways underlying disordered lipid metabolism are incompletely understood. Therefore, we tested whether a mWD chronically fed to lean, insulin-sensitive adult Japanese macaques throughout pregnancy and lactation would impact skeletal muscle oxidative capacity and lipid metabolism in adolescent offspring fed a postweaning (pw) Western-style diet (WD) or control diet (CD). Although body weight was not different, retroperitoneal fat mass and subscapular skinfold thickness were significantly higher in pwWD offspring consistent with elevated fasting insulin and glucose. Maximal complex I (CI)-dependent respiration in muscle was lower in mWD offspring in the presence of fatty acids, suggesting that mWD impacts muscle integration of lipid with nonlipid oxidation. Abundance of all five oxidative phosphorylation complexes and VDAC, but not ETF/ETFDH, were reduced with mWD, partially explaining the lower respiratory capacity with lipids. Muscle triglycerides increased with pwWD; however, the fold increase in lipid saturation, 1,2-diacylglycerides, and C18 ceramide compared between pwCD and pwWD was greatest in mWD offspring. Reductions in CI abundance and VDAC correlated with reduced markers of oxidative stress, suggesting that these reductions may be an early-life adaptation to mWD to mitigate excess reactive oxygen species. Altogether, mWD, independent of maternal obesity or insulin resistance, results in sustained metabolic reprogramming in offspring muscle despite a healthy diet intervention. ARTICLE HIGHLIGHTS In lean, active adolescent offspring, a postweaning Western-style diet (pwWD) leads to shifts in body fat distribution that are associated with poorer insulin sensitivity. Fatty acid-linked oxidative metabolism was reduced in skeletal muscles from offspring exposed to maternal Western-style diet (mWD) even when weaned to a healthy control diet for years. Reduced oxidative phosphorylation complex I-V and VDAC1 abundance partially explain decreased skeletal muscle respiration in mWD offspring. Prior exposure to mWD results in greater fold increase with pwWD in saturated lipids and bioactive lipid molecules (i.e. ceramide and sphingomyelin) associated with insulin resistance.
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Affiliation(s)
| | - Byron Hetrick
- Department of Human Physiology, University of Oregon, Eugene, OR
| | - Bryan C. Bergman
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tyler A. Dean
- Division of Cardiometabolic Health, Oregon Health & Science University, Oregon National Primate Research Center, Beaverton, OR
| | | | - Maureen Gannon
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA
| | - Elinor L. Sullivan
- Division of Neuroscience, Oregon Health & Science University, Oregon National Primate Research Center, Beaverton, OR
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
- Department of Behavioral Sciences, Oregon Health & Science University, Portland, OR
| | - Kjersti M. Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | - Paul Kievit
- Division of Cardiometabolic Health, Oregon Health & Science University, Oregon National Primate Research Center, Beaverton, OR
| | - Adam J. Chicco
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Jacob E. Friedman
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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García-Hermoso A, López-Gil JF, Izquierdo M, Ramírez-Vélez R, Ezzatvar Y. Exercise and Insulin Resistance Markers in Children and Adolescents With Excess Weight: A Systematic Review and Network Meta-Analysis. JAMA Pediatr 2023; 177:1276-1284. [PMID: 37812414 PMCID: PMC10562991 DOI: 10.1001/jamapediatrics.2023.4038] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/10/2023] [Indexed: 10/10/2023]
Abstract
Importance Although benefits have been reported for most exercise modalities, the most effective exercise approaches for reducing insulin resistance in children and adolescents with excess weight and the optimal exercise dose remain unknown. Objective To compare exercise training modalities and their association with changes in insulin resistance markers among children and adolescents with excess weight and to establish the optimal exercise dose. Data Sources For this systematic review and network meta-analysis, 6 electronic databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and CINAHL) were searched for studies from inception to April 1, 2023. Study Selection Randomized clinical trials (ie, randomized controlled trials and randomized trials without a control group) were included if they reported outcomes associated with aerobic training, resistance training, high-intensity interval training (HIIT), or a combination of these interventions. Data Extraction and Synthesis Data extraction for this systematic review was conducted following a network meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Effect sizes were calculated as the mean difference (MD) with 95% CI using random-effects inverse-variance models with the Hartung-Knapp-Sidik-Jonkman method. The hierarchy of competing interventions was defined using the surface under the cumulative ranking curve. The Cochrane Risk-of-Bias tool, version 2 (RoB2), was used to independently assess the risk of bias of the included studies. The certainty of evidence in consistent networks was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. The study protocol was prospectively registered with PROSPERO. Data analyses were conducted between May and June 2023. Main Outcomes and Measures The primary outcomes were fasting glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR). Results This analysis included 55 studies with a total of 3051 children and adolescents (mean [SD] age, 13.5 [2.3] years; 1537 girls [50.4%] and 1514 boys [49.6%]). Exercise was associated with reductions in fasting insulin (MD, -4.38 μU/mL [95% CI, -5.94 to -2.82 μU/mL]) and HOMA-IR (MD, -0.87 [95% CI, -1.20 to -0.53]). A nonlinear association in both markers was observed, with a required minimal exercise dosage of approximately 900 to 1200 metabolic equivalent of task minutes per week, especially in children and adolescents with insulin resistance at baseline. Combination HIIT and resistance training and concurrent training were the most effective approaches for reducing insulin resistance markers. On average, the certainty of evidence varied from low to moderate. Conclusions and Relevance These findings underscore the role of exercise interventions in enhancing insulin resistance markers among children and adolescents with overweight and obesity. It is advisable to include resistance exercises alongside aerobic and HIIT programs for a minimum of two to three 60-minute sessions per week.
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Affiliation(s)
- Antonio García-Hermoso
- Navarrabiomed, Instituto de Investigación Sanitaria de Navarra, Hospital Universitario de Navarra, Universidad Pública de Navarra, Pamplona, Spain
| | - José Francisco López-Gil
- Navarrabiomed, Instituto de Investigación Sanitaria de Navarra, Hospital Universitario de Navarra, Universidad Pública de Navarra, Pamplona, Spain
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Mikel Izquierdo
- Navarrabiomed, Instituto de Investigación Sanitaria de Navarra, Hospital Universitario de Navarra, Universidad Pública de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red Sobre Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Instituto de Investigación Sanitaria de Navarra, Hospital Universitario de Navarra, Universidad Pública de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red Sobre Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
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Galderisi A, Tricò D, Lat J, Samuels S, Weiss R, Van Name M, Pierpont B, Santoro N, Caprio S. Incretin effect determines glucose trajectory and insulin sensitivity in youths with obesity. JCI Insight 2023; 8:e165709. [PMID: 37847560 PMCID: PMC10721315 DOI: 10.1172/jci.insight.165709] [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: 10/03/2022] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
In youths with obesity, the gut hormone potentiation of insulin secretion - the incretin effect - is blunted. We explored the longitudinal impact of the incretin effect during pubertal transition on β cell function and insulin sensitivity. Youths with obesity and 2-hour glucose level ≥ 120 mg/dL underwent a 3-hour oral glucose-tolerance test (OGTT) and an isoglycemic i.v. glucose infusion to quantify the incretin effect. After 2 years, 30 of 39 participants had a repeated OGTT and were stratified into 3 tertiles according to the baseline incretin effect. The high-incretin effect group demonstrated a longitudinal increase in β cell function (disposition index, minimal model [DIMM]), with greater insulin sensitivity at follow-up and stable insulin secretion (φtotal). A lower incretin effect at baseline was associated with higher 1-hour and 2-hour glucose level at follow-up. The high-incretin effect group displayed a greater increase of GLP-17-36 than the moderate- and low-incretin group at baseline, while such a difference did not persist after 2 years. Glucagon suppression was reduced at follow-up in those with low-baseline incretin in respect to the high-incretin group. The incretin effect during pubertal transition affected the longitudinal trajectory of β cell function and weight in youths with obesity.
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Affiliation(s)
- Alfonso Galderisi
- Yale University, Department of Pediatrics, New Haven, Connecticut, USA
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jessica Lat
- Yale University, Department of Pediatrics, New Haven, Connecticut, USA
| | - Stephanie Samuels
- Yale University, Department of Pediatrics, New Haven, Connecticut, USA
| | - Ram Weiss
- Department of Pediatrics, Ruth Rappaport Childrens’ Hospital, Rambam Medical Center, Haifa, Israel
| | - Michelle Van Name
- Yale University, Department of Pediatrics, New Haven, Connecticut, USA
| | - Bridget Pierpont
- Yale University, Department of Pediatrics, New Haven, Connecticut, USA
| | - Nicola Santoro
- Yale University, Department of Pediatrics, New Haven, Connecticut, USA
- Department of Medicine and Health Sciences University of Molise, Campobasso, Italy
| | - Sonia Caprio
- Yale University, Department of Pediatrics, New Haven, Connecticut, USA
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Franceschi R, Fintini D, Ravà L, Mariani M, Aureli A, Inzaghi E, Pedicelli S, Deodati A, Bizzarri C, Cappa M, Cianfarani S, Manco M. Insulin Clearance at the Pubertal Transition in Youth with Obesity and Steatosis Liver Disease. Int J Mol Sci 2023; 24:14963. [PMID: 37834412 PMCID: PMC10573227 DOI: 10.3390/ijms241914963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
No data are available on insulin clearance (ClI) trends during the pubertal transition. The aim of this study was to investigate in 973 youths with obesity whether ClI in fasting and post-oral glucose challenge (OGTT) conditions varies at the pubertal transition in relation to the severity of obesity and the presence of steatosis liver disease (SLD). The severity of obesity was graded according to the Centers for Disease Control. SLD was graded as absent, mild and severe based on alanine amino transferase levels. ClI was defined as the molar ratio of fasting C-peptide to insulin and of the areas under the insulin to glucose curves during an OGTT. In total, 35% of participants were prepubertal, 72.6% had obesity class II, and 52.6% had mild SLD. Fasting ClI (nmol/pmol × 10-2) was significantly lower in pubertal [0.11 (0.08-0.14)] than in prepubertal individuals [0.12 (0.09-0.16)] and higher in class III [0.15 (0.11-0.16)] than in class I obesity [0.11 (0.09-0.14)]. OGTT ClI was higher in boys [0.08 (0.06-0.10)] than in girls [0.07 (0.06-0.09)]; in prepubertal [0.08 (0.06-0.11)] than in pubertal individuals [0.07 (0.05-0.09)]; in class III [0.14 (0.08-0.17)] than in class I obesity [0.07 (0.05-0.10)]; and in severe SLD [0.09 (0.04-0.14)] than in no steatosis [0.06 (0.04-0.17)]. It was lower in participants with prediabetes [0.06 (0.04-0.07)]. OGTT ClI was lower in youths with obesity at puberty along with insulin sensitivity and greater secretion. The findings suggest that the initial increase in ClI in youth with severe obesity and SLD is likely to compensate for hyperinsulinemia and its subsequent decrease at the onset of prediabetes and other metabolic abnormalities.
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Affiliation(s)
- Roberto Franceschi
- Pediatric Department, S. Chiara Hospital of Trento, APSS, 38121 Trento, Italy;
| | - Danilo Fintini
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Lucilla Ravà
- Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy
| | - Michela Mariani
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Alessia Aureli
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Elena Inzaghi
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Stefania Pedicelli
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Annalisa Deodati
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Carla Bizzarri
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
| | - Marco Cappa
- Research Unit, Innovative Therapies for Endocrinopathies, Scientific Directorate, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy;
| | - Stefano Cianfarani
- Diabetes and Growth Disorders Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (D.F.); (M.M.); (A.A.); (E.I.); (S.P.); (A.D.); (C.B.); or (S.C.)
- Department of Systems Medicine, University of Rome ‘Tor Vergata’, 00168 Rome, Italy
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Melania Manco
- Research Unit of Predictive and Preventive Medicine, Bambino Gesù Children’s Hospital, 00146 Rome, Italy
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9
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293517. [PMID: 37577465 PMCID: PMC10418570 DOI: 10.1101/2023.08.02.23293517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Cauzzo C, Chiavaroli V, Di Valerio S, Chiarelli F. Birth size, growth trajectory and later cardio-metabolic risk. Front Endocrinol (Lausanne) 2023; 14:1187261. [PMID: 37342257 PMCID: PMC10277632 DOI: 10.3389/fendo.2023.1187261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023] Open
Abstract
There is increasing evidence of a strong association between intrauterine growth and subsequent development of chronic disease in adult life. Birth size and growth trajectory have been demonstrated to have an impact on cardio-metabolic health, both in childhood and adult life. Hence, careful observation of the children's growth pattern, starting from the intrauterine period and the first years of life, should be emphasized to detect the possible onset of cardio-metabolic sequelae. This allows to intervene on them as soon as they are detected, first of all through lifestyle interventions, whose efficacy seems to be higher when they are started early. Recent papers suggest that prematurity may constitute an independent risk factor for the development of cardiovascular disease and metabolic syndrome, regardless of birth weight. The purpose of the present review is to examine and summarize the available knowledge about the dynamic association between intrauterine and postnatal growth and cardio-metabolic risk, from childhood to adulthood.
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Affiliation(s)
- Chiara Cauzzo
- Department of Pediatrics, University of Chieti, Chieti, Italy
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11
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Gaspar RC, Lyu K, Hubbard BT, Leitner BP, Luukkonen PK, Hirabara SM, Sakuma I, Nasiri A, Zhang D, Kahn M, Cline GW, Pauli JR, Perry RJ, Petersen KF, Shulman GI. Distinct subcellular localisation of intramyocellular lipids and reduced PKCε/PKCθ activity preserve muscle insulin sensitivity in exercise-trained mice. Diabetologia 2023; 66:567-578. [PMID: 36456864 PMCID: PMC11194860 DOI: 10.1007/s00125-022-05838-8] [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: 03/24/2022] [Accepted: 09/30/2022] [Indexed: 12/03/2022]
Abstract
AIMS/HYPOTHESIS Athletes exhibit increased muscle insulin sensitivity, despite increased intramuscular triacylglycerol content. This phenomenon has been coined the 'athlete's paradox' and is poorly understood. Recent findings suggest that the subcellular distribution of sn-1,2-diacylglycerols (DAGs) in the plasma membrane leading to activation of novel protein kinase Cs (PKCs) is a crucial pathway to inducing insulin resistance. Here, we hypothesised that regular aerobic exercise would preserve muscle insulin sensitivity by preventing increases in plasma membrane sn-1,2-DAGs and activation of PKCε and PKCθ despite promoting increases in muscle triacylglycerol content. METHODS C57BL/6J mice were allocated to three groups (regular chow feeding [RC]; high-fat diet feeding [HFD]; RC feeding and running wheel exercise [RC-EXE]). We used a novel LC-MS/MS/cellular fractionation method to assess DAG stereoisomers in five subcellular compartments (plasma membrane [PM], endoplasmic reticulum, mitochondria, lipid droplets and cytosol) in the skeletal muscle. RESULTS We found that the HFD group had a greater content of sn-DAGs and ceramides in multiple subcellular compartments compared with the RC mice, which was associated with an increase in PKCε and PKCθ translocation. However, the RC-EXE mice showed, of particular note, a reduction in PM sn-1,2-DAG and ceramide content when compared with HFD mice. Consistent with the PM sn-1,2-DAG-novel PKC hypothesis, we observed an increase in phosphorylation of threonine1150 on the insulin receptor kinase (IRKT1150), and reductions in insulin-stimulated IRKY1162 phosphorylation and IRS-1-associated phosphoinositide 3-kinase activity in HFD compared with RC and RC-EXE mice, which are sites of PKCε and PKCθ action, respectively. CONCLUSIONS/INTERPRETATION These results demonstrate that lower PKCθ/PKCε activity and sn-1,2-DAG content, especially in the PM compartment, can explain the preserved muscle insulin sensitivity in RC-EXE mice.
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Affiliation(s)
- Rafael C Gaspar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- School of Applied Science, University of Campinas, Limeira, SP, Brazil
| | - Kun Lyu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Brandon T Hubbard
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Brooks P Leitner
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Panu K Luukkonen
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sandro M Hirabara
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Institute of Physical Activity Science and Sports, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Ikki Sakuma
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ali Nasiri
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dongyan Zhang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mario Kahn
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gary W Cline
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel J Perry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Kitt F Petersen
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA.
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12
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Karayakali M, Altinoz E, Elbe H, Koca O, Onal MO, Bicer Y, Demir M. Crocin treatment exerts anti-inflammatory and anti-oxidative effects in liver tissue damage of pinealectomized diabetic rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:47670-47684. [PMID: 36746856 DOI: 10.1007/s11356-023-25766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
Diabetes mellitus (DM) is a chronic metabolic disorder with an increasing global prevalence that leads to significant morbidity and mortality. The liver plays a vital role in glycemic regulation in physiological and pathological conditions such as DM. Free radical formation and inhibition of antioxidant defense systems play a role in the liver damage pathogenesis in diabetic patients The antioxidant, anti-diabetic, anti-inflammatory, and radical scavenging properties of crocin are known. This study was designed to determine the possible protective effects of crocin against liver tissue damage in pinealectomized diabetic rats. Sixty rats were divided into six groups: Control, Sham+streptozotocin (STZ), Pinealectomy (PINX), PINX+STZ, PINX+Crocin, and PINX+STZ+Crocin. PNX procedure was carried out on the first day of the experiment. Intraperitoneal (i.p.) injection of 50 mg/kg STZ was performed on the 30th day of the experiment to induce DM. Crocin (50 mg/kg; i.p.) was applied for 15 days after the pinealectomy procedure and induction of DM. Crocin decreased the markers (alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), interleukin-1β (IL-1β), and malondialdehyde (MDA)) of liver damage and increased antioxidant enzyme levels and tissue total antioxidant status. Histological results showed that the administration of crocin exhibited a protective effect against liver damage caused by STZ. These results indicate that crocin evidence protection against liver injury caused by STZ.
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Affiliation(s)
- Melike Karayakali
- Department of Medical Biochemistry, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - Eyup Altinoz
- Department of Medical Biochemistry, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - Hulya Elbe
- Department of Histology and Embryology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Oguzhan Koca
- Department of Biochemistry, Karabuk University Education and Research Hospital, Karabuk, Turkey
| | - Melike Ozgul Onal
- Department of Histology and Embryology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Yasemin Bicer
- Department of Medical Biochemistry, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - Mehmet Demir
- Department of Physiology, Faculty of Medicine, Karabuk University, Karabuk, Turkey.
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13
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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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14
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Liver Steatosis: A Marker of Metabolic Risk in Children. Int J Mol Sci 2022; 23:ijms23094822. [PMID: 35563210 PMCID: PMC9100068 DOI: 10.3390/ijms23094822] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity is one of the greatest health challenges affecting children of all ages and ethnicities. Almost 19% of children and adolescents worldwide are overweight or obese, with an upward trend in the last decades. These reports imply an increased risk of fat accumulation in hepatic cells leading to a series of histological hepatic damages gathered under the acronym NAFLD (Non-Alcoholic Fatty Liver Disease). Due to the complex dynamics underlying this condition, it has been recently renamed as 'Metabolic Dysfunction Associated Fatty Liver Disease (MAFLD)', supporting the hypothesis that hepatic steatosis is a key component of the large group of clinical and laboratory abnormalities of Metabolic Syndrome (MetS). This review aims to share the latest scientific knowledge on MAFLD in children in an attempt to offer novel insights into the complex dynamics underlying this condition, focusing on the novel molecular aspects. Although there is still no treatment with a proven efficacy for this condition, starting from the molecular basis of the disease, MAFLD's therapeutic landscape is rapidly expanding, and different medications seem to act as modifiers of liver steatosis, inflammation, and fibrosis.
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15
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Al-Beltagi M, Bediwy AS, Saeed NK. Insulin-resistance in paediatric age: Its magnitude and implications. World J Diabetes 2022; 13:282-307. [PMID: 35582667 PMCID: PMC9052009 DOI: 10.4239/wjd.v13.i4.282] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/12/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Insulin resistance (IR) is insulin failure in normal plasma levels to adequately stimulate glucose uptake by the peripheral tissues. IR is becoming more common in children and adolescents than before. There is a strong association between obesity in children and adolescents, IR, and the metabolic syndrome components. IR shows marked variation among different races, crucial to understanding the possible cardiovascular risk, specifically in high-risk races or ethnic groups. Genetic causes of IR include insulin receptor mutations, mutations that stimulate autoantibody production against insulin receptors, or mutations that induce the formation of abnormal glucose transporter 4 molecules or plasma cell membrane glycoprotein-1 molecules; all induce abnormal energy pathways and end with the development of IR. The parallel increase of IR syndrome with the dramatic increase in the rate of obesity among children in the last few decades indicates the importance of environmental factors in increasing the rate of IR. Most patients with IR do not develop diabetes mellitus (DM) type-II. However, IR is a crucial risk factor to develop DM type-II in children. Diagnostic standards for IR in children are not yet established due to various causes. Direct measures of insulin sensitivity include the hyperinsulinemia euglycemic glucose clamp and the insulin-suppression test. Minimal model analysis of frequently sampled intravenous glucose tolerance test and oral glucose tolerance test provide an indirect estimate of metabolic insulin sensitivity/resistance. The main aim of the treatment of IR in children is to prevent the progression of compensated IR to decompensated IR, enhance insulin sensitivity, and treat possible complications. There are three main lines for treatment: Lifestyle and behavior modification, pharmacotherapy, and surgery. This review will discuss the magnitude, implications, diagnosis, and treatment of IR in children.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama 12, Bahrain
- Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
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Manzano M, Giron MD, Salto R, Vilchez JD, Reche-Perez FJ, Cabrera E, Linares-Pérez A, Plaza-Díaz J, Ruiz-Ojeda FJ, Gil A, Rueda R, López-Pedrosa JM. Quality More Than Quantity: The Use of Carbohydrates in High-Fat Diets to Tackle Obesity in Growing Rats. Front Nutr 2022; 9:809865. [PMID: 35425792 PMCID: PMC9002105 DOI: 10.3389/fnut.2022.809865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Childhood obesity prevention is important to avoid obesity and its comorbidities into adulthood. Although the energy density of food has been considered a main obesogenic factor, a focus on food quality rather that the quantity of the different macronutrients is needed. Therefore, this study investigates the effects of changing the quality of carbohydrates from rapidly to slowly digestible carbohydrates on metabolic abnormalities and its impact on obesity in growing rats fed a high-fat diet (HFD). Growing rats were fed on HFD containing carbohydrates with different digestion rates: a HFD containing rapid-digesting carbohydrates (OBE group) or slow-digesting carbohydrates (ISR group), for 4 weeks and the effect on the metabolism and signaling pathways were analyzed in different tissues. Animals from OBE group presented an overweight/obese phenotype with a higher body weight gain and greater accumulation of fat in adipose tissue and liver. This state was associated with an increase of HOMA index, serum diacylglycerols and triacylglycerides, insulin, leptin, and pro-inflammatory cytokines. In contrast, the change of carbohydrate profile in the diet to one based on slow digestible prevented the obesity-related adverse effects. In adipose tissue, GLUT4 was increased and UCPs and PPARγ were decreased in ISR group respect to OBE group. In liver, GLUT2, FAS, and SRBP1 were lower in ISR group than OBE group. In muscle, an increase of glycogen, GLUT4, AMPK, and Akt were observed in comparison to OBE group. In conclusion, this study demonstrates that the replacement of rapidly digestible carbohydrates for slowly digestible carbohydrates within a high-fat diet promoted a protective effect against the development of obesity and its associated comorbidities.
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Affiliation(s)
| | - Maria D. Giron
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
| | - Rafael Salto
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
- *Correspondence: Rafael Salto,
| | - Jose D. Vilchez
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
| | - Francisco J. Reche-Perez
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
| | - Elena Cabrera
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
| | - Azahara Linares-Pérez
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
| | - Julio Plaza-Díaz
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Complejo Hospitalario Universitario de Granada, Granada, Spain
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Francisco Javier Ruiz-Ojeda
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Complejo Hospitalario Universitario de Granada, Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix,” University of Granada, Granada, Spain
| | - Angel Gil
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix,” University of Granada, Granada, Spain
- CIBEROBN Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
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Córdoba-Rodríguez DP, Iglesia I, Gomez-Bruton A, Rodríguez G, Casajús JA, Morales-Devia H, Moreno LA. Fat-free/lean body mass in children with insulin resistance or metabolic syndrome: a systematic review and meta-analysis. BMC Pediatr 2022; 22:58. [PMID: 35065638 PMCID: PMC8783460 DOI: 10.1186/s12887-021-03041-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 11/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lean / Fat Free Body Mass (LBM) is metabolically involved in active processes such as resting energy expenditure, glucose uptake, and myokine secretion. Nonetheless, its association with insulin sensitivity / resistance / glucose tolerance and metabolic syndrome remains unclear in childhood. METHODS The current investigation aimed to examine the differences in fat-free mass /lean body mass according to the presence of insulin sensitivity/insulin resistance/glucose tolerance/metabolic syndrome in children. A systematic search was carried out in Medline/PubMed, Embase, Scopus, Web of Science, and SciELO, covering the period from each database's respective start to 21 June 2021. Two researchers evaluated 7111 studies according to the inclusion criteria: original human studies, written in English or Spanish, evaluating fat-free mass/lean body mass in children and adolescents including both with and without insulin sensitivity/insulin resistance /glucose tolerance and metabolic syndrome and reported the differences between them in terms of fat free mass/lean body mass. The results of the studies were combined with insulin sensitivity, insulin, resistance, glucose tolerance and metabolic syndrome. The standardized mean difference (SMD) in each study was calculated and combined using the random-effects model. Heterogeneity between studies was tested using the index of heterogeneity (I2), leave-one-out sensitivity analyses were performed, and publication bias was assessed using the Egger and Begg tests. RESULTS Finally, 15 studies which compared groups defined according to different glucose homeostasis criteria or metabolic syndrome out of 103 eligible studies were included in this systematic review and 12 studies in the meta-analysis. Meta-analysis showed lower fat-free mass/lean body mass percentage in participants with insulin resistance/glucose tolerance/metabolic syndrome (SMD -0.47; 95% CI, - 0.62 to - 0.32) while in mass units (kg), higher values were found in the same group (SMD, 1.01; 95% CI, 0.43 to 1.60). CONCLUSIONS Our results identified lower values of fat-free mass/lean body mass (%) in children and adolescents with insulin resistance/glucose tolerance/metabolic syndrome and higher values of fat-free mass/lean body mass when these are expressed in kg. The evidence of the impact of lean mass on children's glucose homeostasis or metabolic syndrome is limited, so future studies research should focus on explaining the effect of fat-free mass/lean body mass on different metabolic outcomes. Moreover, it may be interesting to evaluate the quality (muscle density) or functional (muscle strength) outcomes in addition to both absolute (kg) and relative (%) values in future studies. The systematic review was prospectively registered at PROSPERO (registration number CRD42019124734; available at: http://www.crd.york.ac.uk/prospero [accessed: 05 April 2019]).
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Affiliation(s)
| | - Iris Iglesia
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Gomez-Bruton
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerardo Rodríguez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Pediatría, Universidad de Zaragoza, Zaragoza, Spain
| | - José Antonio Casajús
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Hernan Morales-Devia
- Biblioteca General Alfonso Borrero Cabal, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Luis A. Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
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Chung YL, Rhie YJ. Severe Obesity in Children and Adolescents: Metabolic Effects, Assessment, and Treatment. J Obes Metab Syndr 2021; 30:326-335. [PMID: 34924365 PMCID: PMC8735819 DOI: 10.7570/jomes21063] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
Childhood obesity has been increasing steadily in recent decades, and severe childhood obesity has emerged as a major public health problem both nationally and internationally. A current concern is that lockdown due to the coronavirus disease 2019 (COVID-19) pandemic could exacerbate the spread of childhood obesity and increase the gap in obesity risk. Recent research results indicate the aggravation of obesity after school closures. The consequences of severe childhood obesity are more devastating than those of mild to moderate obesity. Children with severe obesity are at greater risk than others for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Accurately assessing and diagnosing a child with severe obesity is the key to implementing successful therapy. A detailed and accurate patient history and physical examination are important to discriminate monogenic obesity and metabolic syndrome diagnoses from severe obesity without an underlying cause. Psychosocial factors, including eating behaviors, should be assessed to facilitate better weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. However, lifestyle modification should be the priority. Although progress has been made, safe and effective treatment for severe pediatric obesity is still challenging. More efforts and innovations are needed to find a solution for the huge medical and emotional burden that these children and their families carry. Public health organizations also need to make efforts to encourage and normalize healthy eating habits and exercise to prevent severe obesity in childhood.
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Affiliation(s)
- Yoojin Lindsey Chung
- Department of Pediatrics, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
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19
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Tarabra E, Nouws J, Vash-Margita A, Hellerstein M, Shabanova V, McCollum S, Pierpont† B, Zhao D, Shulman GI, Caprio S. CIDEA expression in SAT from adolescent girls with obesity and unfavorable patterns of abdominal fat distribution. Obesity (Silver Spring) 2021; 29:2068-2080. [PMID: 34672413 PMCID: PMC8612981 DOI: 10.1002/oby.23295] [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: 06/23/2021] [Revised: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study investigated whether variations in cell death-inducing DNA fragmentation factor alpha subunit-like effector A (CIDEA) mRNA expression and protein levels are modulated by the pattern of abdominal fat distribution in adolescent girls with obesity. METHODS This study recruited 35 adolescent girls with obesity and characterized their abdominal fat distribution by magnetic resonance imaging. Participants had only a periumbilical/abdominal (n = 14) or a paired abdominal and gluteal subcutaneous adipose tissue (SAT) biopsy (n = 21). CIDEA expression was determined by reverse transcription-polymerase chain reaction, CIDEA protein level by Western blot, and the turnover of adipose lipids and adipocytes by 2 H2 O labeling. In six girls, a second abdominal SAT biopsy was performed (after ~34.2 months) to explore the weight gain effect on CIDEA expression in abdominal SAT. RESULTS CIDEA expression decreased in abdominal SAT from participants with high visceral adipose tissue (VAT)/(VAT+SAT); CIDEA inversely correlated with number of small adipocytes, with the increase in preadipocyte proliferation, and with adipogenesis. A strong inverse correlation was found between CIDEA protein level with the newly synthetized glycerol (r = -0.839, p = 0.0047). Following weight gain, an increase in adipocytes' cell diameter with a decrease in CIDEA expression and RNA-sequencing transcriptomic profile typical of adipocyte dysfunction was observed. CONCLUSIONS Reduced expression of CIDEA in girls with high VAT/(VAT+SAT) is associated with adipocyte hypertrophy and insulin resistance.
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Affiliation(s)
- Elena Tarabra
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica Nouws
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA, USA
| | - Veronika Shabanova
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Sarah McCollum
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Bridget Pierpont†
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Dejian Zhao
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Sonia Caprio
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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Bonet J, Galuppo B, Santoro N, DallaMan C. A New Oral Model to Assess Postprandial Lactate Production Rate. IEEE Trans Biomed Eng 2021; 69:1533-1540. [PMID: 34727021 DOI: 10.1109/tbme.2021.3124143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Pediatric obesity predisposes children and adolescents to early onset insulin resistance and dysglycemia. In the last 20 years this has led to a rise in the prevalence of prediabetes, diabetes and fatty liver in youngsters, due to the high degree of insulin resistance experienced by these patients and the consequent high availability of glucose. As glucose accesses the liver, it is partly metabolized through glycolysis, whose main product is pyruvate that is then converted into Acetyl CoA and lactate. Therefore, lactate production rate (LPR) represents the best proxy for the assessment of glycolysis. Since to date there are not methods to estimate postprandial LPR, here we proposed a novel oral glucose-lactate model to estimate LPR during an oral glucose tolerance test and tested it in 24 youth with and without obesity. METHODS The model is based on the oral glucose minimal model and assumes that LPR is a fraction (fr) of glucose disposal rate, proportional to glucose concentration and controlled by insulin action. RESULTS The model well fitted the glucose and lactate data, and provided both precise parameter estimates (e.g. fr=22.5 [12.6-54.1]%, median [IQR]), CV=18 [13-25]%) and LPR time course. CONCLUSIONS The proposed model is a valid tool to assess LPR, and thus glycolysis, during OGTT in nondiabetic subjects. SIGNIFICANCE The proposed methodology will allow to assess postprandial LPR in simple and cost-effective way.
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21
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Chung E, Gonzalez K, Ullevig SL, Zhang J, Umeda M. Obesity, not a high fat, high sucrose diet alone, induced glucose intolerance and cardiac dysfunction during pregnancy and postpartum. Sci Rep 2021; 11:18057. [PMID: 34508150 PMCID: PMC8433413 DOI: 10.1038/s41598-021-97336-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular disease is the leading cause of death in women during pregnancy and the postpartum period. Obesity is an independent risk factor for cardiovascular diseases. Nearly 60% of women of reproductive age are considered overweight or obese, cardiovascular disease morbidity and mortality continue to be pervasive. The objective of this study was to determine the effects of an obesogenic diet on the cardiometabolic health of dams during pregnancy and postpartum. Female mice were fed either a high-fat, high-sucrose diet (HFHS) or a refined control diet (CON) for 8 weeks before initiation of pregnancy and throughout the study period. Mice in the HFHS showed two distinct phenotypes, obesity-prone (HFHS/OP) and obesity resistance (HFHS/OR). Pre-pregnancy obesity (HFHS/OP) induced glucose intolerance before pregnancy and during postpartum. Systolic function indicated by the percent fractional shortening (%FS) was significantly decreased in the HFHS/OP at late pregnancy (vs. HFHS/OR) and weaning (vs. CON), but no differences were found at 6 weeks of postpartum among groups. No induction of pathological cardiac hypertrophy markers was found during postpartum. Plasma adiponectin was decreased while total cholesterol was increased in the HFHS/OP. Our results suggested that obesity, not the diet alone, negatively affected cardiac adaptation during pregnancy and postpartum.
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Affiliation(s)
- Eunhee Chung
- Department of Kinesiology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Kassandra Gonzalez
- Department of Kinesiology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - Sarah L Ullevig
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - John Zhang
- Department of Kinesiology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | - Masataka Umeda
- Department of Kinesiology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
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22
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Westphal Ladfors S, Bergdahl E, Hermannsson O, Kristjansson J, Linnér T, Brandström P, Hansson S, Dangardt F. Longitudinal Follow-Up on Cardiopulmonary Exercise Capacity Related to Cardio-Metabolic Risk Factors in Children With Renal Transplants. Front Sports Act Living 2021; 3:688383. [PMID: 34485901 PMCID: PMC8415396 DOI: 10.3389/fspor.2021.688383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Children with chronic kidney disease, including those treated with kidney transplantation (KT), have an increased risk of cardiovascular disease. The aim of this study was to examine the cardiopulmonary exercise capacity after KT compared to matched controls, to relate the results to physical activity, blood pressure and biochemical findings and to follow exercise capacity over time. Methods: Patients with KT (n = 38, age 7.7–18 years), with a mean time from transplantation of 3.7 years (0.9–13.0) and mean time in dialysis 0.8 years, were examined at inclusion and annually for up to three years. Healthy controls (n = 17, age 7.3–18.6 years) were examined once. All subjects underwent a cardiopulmonary exercise test, resting blood pressure measurement, anthropometry and activity assessment. Patients also underwent echocardiography, dual-energy X-ray absorptiometry (DXA), 24-h ambulatory BP measurements (ABPM), assessment of glomerular filtration rate (GFR) and blood sampling annually. Results: As compared to healthy controls, KT patients showed decreased exercise capacity measured both as VO2peak (34.5 vs. 43.9 ml/kg/min, p < 0.001) and maximal load (2.6 vs. 3.5 W/kg, p < 0.0001), similarly as when results were converted to z-scores. No significant difference was found in weight, but the KT patients were shorter and had higher BMI z-score than controls, as well as increased resting SBP and DBP z-scores. The patient or parent reported physical activity was significantly lower in the KT group compared to controls (p < 0.001) In the combined group, the major determinants for exercise capacity z-scores were activity score and BMI z-score (β = 0.79, p < 0.0001 and β = −0.38, p = 0.007, respectively). Within the KT group, low exercise capacity was associated with high fat mass index (FMI), low activity score, low GFR and high blood lipids. In the multivariate analysis FMI and low GFR remained predictors of low exercise capacity. The longitudinal data for the KT patients showed no change in exercise capacity z-scores over time. Conclusion: Patients with KT showed decreased exercise capacity and increased BP as compared to healthy controls. Exercise capacity was associated to GFR, physical activity, FMI and blood lipids. It did not improve during follow-up.
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Affiliation(s)
| | - Ebba Bergdahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oli Hermannsson
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Julius Kristjansson
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Tina Linnér
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.,Pediatric Clinical Physiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Per Brandström
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sverker Hansson
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Dangardt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pediatric Clinical Physiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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23
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Karimifard M, Aminorroaya A, Amini M, Kachuie A, Feizi A, Yamini SA, Alijanvand MH. The effect of alendronate on lipid profile of postmenopausal women with osteopenia and prediabetes: A randomized triple-blind clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:52. [PMID: 34729060 PMCID: PMC8506247 DOI: 10.4103/jrms.jrms_579_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/05/2020] [Accepted: 03/01/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Prediabetes is a high-risk state for developing diabetes at an annual rate of 5%-10%. Early intervention can prevent further complications, including metabolic syndrome. Bisphosphonates are commonly used for osteoporotic postmenopausal women. The purpose of this study was to assess the effects of bisphosphonates on lipid profile including triglyceride (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) of prediabetic postmenopausal women with osteopenia. MATERIALS AND METHODS In this triple-blind randomized controlled trial, sixty prediabetic, postmenopausal women with sufficient Vitamin D and osteopenia, aged 45-60 years, were randomly enrolled in two groups of intervention (receiving 70-mg alendronate for 12 weeks [duration for maximum metabolic effect of bisphosphonates], n = 30) and control (receiving placebo, n = 30) according to a randomized block procedure of size 2 and 1:1 allocation ratio. The primary outcome of the study, the lipid profile, was evaluated before and after the interventions. The effect of the intervention was assessed using analysis of covariance. RESULTS The lipid profiles showed no significant differences to the mean values at the baseline in both the groups (all P > 0.05). At the end of the study, the differences between the groups were not significant for 25(OH) D3 (mean difference: -11.09, 95% confidence interval: -32.43-10.25), T (4.19, -30.58-38.97), cholesterol (8.13, -13.07-29.33), LDL-cholesterol (5.07, -10.18-20.31), and HDL-cholesterol (-0.86, -6.04-4.31) when the baseline values and confounders were adjusted (all P > 0.05). CONCLUSION No statistically significant difference was detected in the serum lipid profile of prediabetic postmenopausal women with osteopenia as a result of alendronate intervention. More studies with larger sample sizes and longer intervention periods are recommended.
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Affiliation(s)
- Maryam Karimifard
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Massoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Kachuie
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, Endocrine and Metabolism Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sima Aminorroaya Yamini
- Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield, England, UK
| | - Moluk Hadi Alijanvand
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Scapaticci S, D’Adamo E, Mohn A, Chiarelli F, Giannini C. Non-Alcoholic Fatty Liver Disease in Obese Youth With Insulin Resistance and Type 2 Diabetes. Front Endocrinol (Lausanne) 2021; 12:639548. [PMID: 33889132 PMCID: PMC8056131 DOI: 10.3389/fendo.2021.639548] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Currently, Non-Alcoholic Fatty Liver Disease (NAFLD) is the most prevalent form of chronic liver disease in children and adolescents worldwide. Simultaneously to the epidemic spreading of childhood obesity, the rate of affected young has dramatically increased in the last decades with an estimated prevalence of NAFLD of 3%-10% in pediatric subjects in the world. The continuous improvement in NAFLD knowledge has significantly defined several risk factors associated to the natural history of this complex liver alteration. Among them, Insulin Resistance (IR) is certainly one of the main features. As well, not surprisingly, abnormal glucose tolerance (prediabetes and diabetes) is highly prevalent among children/adolescents with biopsy-proven NAFLD. In addition, other factors such as genetic, ethnicity, gender, age, puberty and lifestyle might affect the development and progression of hepatic alterations. However, available data are still lacking to confirm whether IR is a risk factor or a consequence of hepatic steatosis. There is also evidence that NAFLD is the hepatic manifestation of Metabolic Syndrome (MetS). In fact, NAFLD often coexist with central obesity, impaired glucose tolerance, dyslipidemia, and hypertension, which represent the main features of MetS. In this Review, main aspects of the natural history and risk factors of the disease are summarized in children and adolescents. In addition, the most relevant scientific evidence about the association between NAFLD and metabolic dysregulation, focusing on clinical, pathogenetic, and histological implication will be provided with some focuses on the main treatment options.
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Affiliation(s)
| | | | | | | | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy
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25
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Kim JY, Jeon JY. Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes? Ann Pediatr Endocrinol Metab 2020; 25:208-216. [PMID: 33401879 PMCID: PMC7788350 DOI: 10.6065/apem.2040140.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022] Open
Abstract
Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.
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Affiliation(s)
- Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Justin Y. Jeon
- Department of Sport Industry Studies, Exercise Medicine Center for Diabetes and Cancer Patients, ICONS Yonsei University, Seoul, Korea,Address for correspondence: Justin Y. Jeon, PhD Department of Sport Industry Studies, Exercise Medicine Center for Diabetes and Cancer Patients, ICONS Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2123-6197 E-mail:
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Dietary Patterns and Their Association with Body Composition and Cardiometabolic Markers in Children and Adolescents: Genobox Cohort. Nutrients 2020; 12:nu12113424. [PMID: 33171599 PMCID: PMC7695147 DOI: 10.3390/nu12113424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022] Open
Abstract
Diet is a key factor for obesity development; however, limited data are available on dietary cluster analysis in children with obesity. We aimed to assess the associations between dietary patterns and obesity and several cardiometabolic markers. Anthropometry, bioelectrical impedance, blood pressure and plasma biomarkers of oxidative stress, inflammation and endothelial damage were determined in 674 Caucasian children, aged 5-16, with normal or excess weight. Using a food frequency questionnaire and cluster analysis, two consistent dietary patterns were shown, labeled as health conscious (HC) and sweet and processed (SP). The HC pattern included a greater proportion of participants with overweight/obesity than the SP cluster (80.1% vs. 63.8%). However, children with obesity within the HC cluster, showed less abdominal fat, through waist to hip (0.93 vs. 0.94) and waist to height (0.61 vs. 0.63) indexes (p < 0.01). Univariate general models showed several additional differences in cardiometabolic risk biomarkers in the global and stratified analyses, with a healthier profile being observed mainly in the HC cluster. However, multivariate models questioned these findings and pointed out the need for further studies in this field. Anyhow, our findings support the benefits of a healthy diet and highlight the importance of dietary patterns in the cardiometabolic risk assessment of children with overweight/obesity, beyond weight control.
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Acierno C, Caturano A, Pafundi PC, Nevola R, Adinolfi LE, Sasso FC. Nonalcoholic fatty liver disease and type 2 diabetes: pathophysiological mechanisms shared between the two faces of the same coin. EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The pathophysiological mechanisms underlying the close relationship between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are multiple, complex and only partially known. The purpose of this paper was to review the current knowledge of these mechanisms in a unified manner. Subjects with NAFLD and T2DM have established insulin resistance (IR), which exacerbates the two comorbidities. IR worsens NAFLD by increasing the accumulation of free fatty acids (FFAs) in the liver. This occurs due to an increase in the influx of FFAs from peripheral adipose tissue by the activation of hormone-sensitive lipase. In addition, there is de novo increased lipogenesis, a transcription factor, the sterols regulatory element-binding transcription factor 1c (SREBP-1c), which activates the expression of several genes strongly promotes lipogenesis by the liver and facilitate storage of triglycerides. Lipids accumulation in the liver induces a chronic stress in the endoplasmic reticulum of the hepatocytes. Genome-wide association studies have identified genetic variants associated with NAFLD severity, but unrelated to IR. In particular, the alteration of patatin-like phospholipase domain-containing protein 3 contributes to the susceptibility to NAFLD. Furthermore, the lipotoxicity of ceramides and diacylglycerol, well known in T2DM, triggers a chronic inflammatory process favoring the progression from hepatic steatosis to steatohepatitis. Reactive oxygen species produced by mitochondrial dysfunction trigger both liver inflammation and beta-cells damage, promoting the progression of both NAFLD and T2DM. The close association between NAFLD and T2DM is bidirectional, as T2DM may trigger both NAFLD onset and its progression, but NAFLD itself may contribute to the development of IR and T2DM. Future studies on the mechanisms will have to deepen the knowledge of the interaction between the two pathologies and should allow the identification of new therapeutic targets for the treatment of NAFLD, currently substantially absent.
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Affiliation(s)
- Carlo Acierno
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, I-80138 Naples, Ital
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Abstract
PURPOSE OF REVIEW It is well known that obesity represents the main modifiable risk factor for insulin resistance in children and adolescents; obesity-induced insulin resistance in children is the most important risk factor for developing cardiovascular diseases and type 2 diabetes in adulthood. The mechanisms through which obesity causes insulin resistance are complex and not completely known to date. RECENT FINDINGS In children, global adiposity is the main factor determining insulin resistance. Excessive fatty acids play a determinant role in the pathogenesis of insulin resistance in obese children, inducing an increased production of acetyl-CoA in the liver and enhancing inflammation in adipose tissue. The aetiology of insulin resistance in polycystic ovary syndrome is multifactorial and still debated. SUMMARY The aim of this review is to present an updated frame and new insights of the numerous pathways involved in the development of insulin resistance in obese patients, focusing on the peculiarities of children and adolescents. Improving the knowledge of mechanisms through which obesity leads to insulin resistance is fundamental in order to recommend particular follow-up and possible treatment to specific categories of obese children and adolescents.
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Wang HH, Lee DK, Liu M, Portincasa P, Wang DQH. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr 2020; 23:189-230. [PMID: 32483543 PMCID: PMC7231748 DOI: 10.5223/pghn.2020.23.3.189] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Caprio S, Santoro N, Weiss R. Childhood obesity and the associated rise in cardiometabolic complications. Nat Metab 2020; 2:223-232. [PMID: 32694781 PMCID: PMC9425367 DOI: 10.1038/s42255-020-0183-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/17/2020] [Indexed: 02/06/2023]
Abstract
Childhood obesity is one of the most serious global public-health challenges of the twenty-first century. Over the past four decades, the number of children and adolescents with obesity has risen more than tenfold. Worldwide, an increasing number of youth are facing greater exposure to obesity throughout their lives, and this increase will contribute to the early development of type 2 diabetes, fatty liver and cardiovascular complications. Herein, we provide a brief overview of trends in the global shifts in, and environmental and genetic determinants of, childhood obesity. We then discuss recent progress in the elucidation of the central role of insulin resistance, the key element linking obesity and cardiovascular-risk-factor clustering, and the potential mechanisms through which ectopic lipid accumulation leads to insulin resistance and its associated cardiometabolic complications in obese adolescents. In the absence of effective prevention and intervention programs, childhood obesity will have severe public-health consequences for decades to come.
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Affiliation(s)
- Sonia Caprio
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
| | - Nicola Santoro
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
| | - Ram Weiss
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Technion School of Medicine, Haifa, Israel.
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Popović Hadžija M, Siketić Z, Hadžija M, Barac M, Bogdanović Radović I. Study of the diacylglycerol composition in the liver and serum of mice with prediabetes and diabetes using MeV TOF-SIMS. Diabetes Res Clin Pract 2020; 159:107986. [PMID: 31866525 DOI: 10.1016/j.diabres.2019.107986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/15/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
AIMS Hepatic insulin resistance, induced by fat, occurs before peripheral resistance and leads to prediabetes and diabetes. If insulin resistance is detected earlier, lifestyle changes could prevent or delay disease development. Therefore, we analysed lipids in the liver and serum of prediabetic and diabetic mice by MeV TOF-SIMS with a focus on diacylglycerols (DAGs) as the best predictor of (liver) resistance. METHODS Glucose impairment was spontaneously developed or induced by HFD in NOD/LtJ mice, and prediabetic and diabetic mice were selected according to their glucose levels. MeV TOF-SIMS was applied to image the lipid distribution in the liver and to relatively quantify lipids related to insulin resistance in both the liver and serum. RESULTS The same lipids were detected in the liver and serum but with different intensities between mice. The intensity of DAGs and fatty acids was higher in the diabetic than that in the prediabetic liver. Imaging of liver tissue showed a more compact density of prediabetic (non-fatty) than diabetic liver with DAG remodelling in diabetes. DAGs, which are greatly increased in diabetic serum, were successfully detected and quantified already in prediabetes. CONCLUSION MeV TOF-SIMS applied to the serum presents an excellent tool for in vivo monitoring of disease development over time.
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Affiliation(s)
- Marijana Popović Hadžija
- Division of Molecular Medicine, Laboratory for Mitochondrial Bioenergetics and Diabetes, Ruđer Bošković Institute, Bijenička cesta 54, 10000 Zagreb, Croatia.
| | - Zdravko Siketić
- Division of Experimental Physics, Laboratory for Ion Beam Interactions, Ruđer Bošković Institute, Bijenička cesta 54, 10000 Zagreb, Croatia
| | - Mirko Hadžija
- Division of Molecular Medicine, Laboratory for Mitochondrial Bioenergetics and Diabetes, Ruđer Bošković Institute, Bijenička cesta 54, 10000 Zagreb, Croatia
| | - Marko Barac
- Division of Experimental Physics, Laboratory for Ion Beam Interactions, Ruđer Bošković Institute, Bijenička cesta 54, 10000 Zagreb, Croatia
| | - Iva Bogdanović Radović
- Division of Experimental Physics, Laboratory for Ion Beam Interactions, Ruđer Bošković Institute, Bijenička cesta 54, 10000 Zagreb, Croatia
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Valaiyapathi B, Gower B, Ashraf AP. Pathophysiology of Type 2 Diabetes in Children and Adolescents. Curr Diabetes Rev 2020; 16:220-229. [PMID: 29879890 PMCID: PMC7516333 DOI: 10.2174/1573399814666180608074510] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of type 2 diabetes (DM) in children is disturbingly increasing in parallel with the increasing childhood obesity. Better knowledge regarding the pathophysiology of type 2 DM in children is paramount to devise an effective management plan. OBJECTIVE Discuss the pathophysiology of type 2 DM in children and adolescents. METHODS AND RESULTS This is a comprehensive review of the literature on this topic. Type 2 DM in childhood is viewed as a continuum of insulin resistance (IR) which is determined by an underlying genetic predisposition, intrauterine environment, excessive food consumption, continued rapid weight gain, and poor lifestyle. Besides IR, this is compounded by multiple metabolic defects including β-cell dysfunction and inadequate insulin secretion, α-cell dysfunction, hyperglucagonemia and increased hepatic glucose production, lipotoxicity, inflammation, deficiencies in incretin production and action, and increased renal glucose reabsorption. The confluence of genetic and environmental factors underscores the complexity in disease progression. CONCLUSION A consistent single risk factor for type 2 DM is obesity and related IR and therefore it is essential to curtail the progression of obesity. It is important to investigate the role of stringent dietary and nutritional approaches, medications that enhance β-cell function and insulin sensitivity.
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Affiliation(s)
- Badhma Valaiyapathi
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Gower
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ambika P. Ashraf
- Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, The University of Alabama at Birmingham, Birmingham, AL, USA
- Address correspondence to this author at the Department Pediatric Endocrinology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; Tel: 205 638 9107, Fax: 205 638 9821; E-mail:
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Lin LY, Hsu CY, Lee HA, Tinkov AA, Skalny AV, Wang WH, Chao JCJ. Gender difference in the association of dietary patterns and metabolic parameters with obesity in young and middle-aged adults with dyslipidemia and abnormal fasting plasma glucose in Taiwan. Nutr J 2019; 18:75. [PMID: 31733645 PMCID: PMC6858632 DOI: 10.1186/s12937-019-0503-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The increasing prevalence of obesity has become a pandemic problem, and dietary patterns are one of the important factors causing obesity. Although the correlation between dietary patterns and obesity has been well explored, the gender difference on the association between dietary patterns and obesity remains unclear. The objective of this study examined whether gender difference existed in the relationship of dietary patterns with metabolic parameters and specific indices of adiposity among young and middle-aged adults with dyslipidemia and abnormal fasting plasma glucose (FPG) in Taiwan. METHODS A total of 14,087 subjects aged between 20 and 50 years with dyslipidemia and abnormal FPG were recruited in Taiwan between 2001 and 2010 for a cross-sectional study. Dyslipidemia was defined primarily according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with minor modification. Abnormal FPG level was defined by the American Diabetes Association. Principal component analysis was conducted to identify dietary patterns. Multivariate logistic regression analysis was performed to evaluate the association of dietary patterns and metabolic parameters with different indices of adiposity including general obesity, central obesity, and high body fat, stratified by gender. RESULTS Two dietary patterns derived from principal component analysis were the prudent dietary pattern and the western dietary pattern. Both men and women in the highest quartile of the western dietary pattern had a significantly increased odds ratio of general obesity, central obesity, and high body fat. However, only male subjects in the higher quartiles of the prudent dietary pattern had a significantly decreased odds ratio of all indices of obesity. Both men and women with higher high-density lipoprotein cholesterol and total cholesterol levels had a significantly reduced odds ratio of general and central obesity, while those with higher triglycerides and FPG levels had a significantly increased odds ratio of general and central obesity. Higher low-density lipoprotein cholesterol level was significantly associated with an elevated odds ratio of high body fat, while higher total cholesterol level was significantly correlated with a reduced odds ratio of high body fat only in women. CONCLUSIONS Gender difference exists in the association of dietary patterns and metabolic parameters with obesity and body fat in young and middle-aged adults with dyslipidemia and abnormal FPG in Taiwan.
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Affiliation(s)
- Li-Yin Lin
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, 365 Ming-Te Road, Peitou District, Taipei, 11219, Taiwan.,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan
| | - Hsiu-An Lee
- Department of Computer Science and Information Engineering, Tamkang University, 151 Yingzhuan Road, Tamsui District, New Taipei, 25137, Taiwan
| | - Alexey A Tinkov
- Yaroslavl State University, Yaroslavl, 150003, Russia.,IM Sechenov First Moscow State Medical University, Moscow, 119146, Russia.,RUDN University, Moscow, 117198, Russia
| | - Anatoly V Skalny
- IM Sechenov First Moscow State Medical University, Moscow, 119146, Russia.,RUDN University, Moscow, 117198, Russia.,Federal Research Centre of Biological Systems and Agro-technologies of the Russian Academy of Sciences, Orenburg, 460000, Russia
| | - Wan-Hsiang Wang
- Department of Information Management, National Taipei University of Nursing and Health Sciences, 365 Ming-Te Road, Peitou District, Taipei, 11219, Taiwan
| | - Jane C-J Chao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan. .,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan. .,Nutrition Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei, 11031, Taiwan.
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Preparation of Ganoderma lucidum polysaccharide‑chromium (III) complex and its hypoglycemic and hypolipidemic activities in high-fat and high-fructose diet-induced pre-diabetic mice. Int J Biol Macromol 2019; 140:782-793. [DOI: 10.1016/j.ijbiomac.2019.08.072] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 12/23/2022]
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Galderisi A, Polidori D, Weiss R, Giannini C, Pierpont B, Tricò D, Caprio S. Lower Insulin Clearance Parallels a Reduced Insulin Sensitivity in Obese Youths and Is Associated With a Decline in β-Cell Function Over Time. Diabetes 2019; 68:2074-2084. [PMID: 31399433 PMCID: PMC6804624 DOI: 10.2337/db19-0120] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/03/2019] [Indexed: 12/17/2022]
Abstract
We examined the relationship between insulin clearance, insulin sensitivity, and β-cell function and the longitudinal effect of insulin clearance on β-cell function in lean and obese insulin-sensitive and insulin-resistant adolescents. A hyperinsulinemic-euglycemic and a hyperglycemic clamp were performed in 110 youths to quantify hepatic and peripheral clearance, insulin sensitivity, and β-cell function (disposition index, DIh-clamp). Participants underwent an oral glucose tolerance test at baseline and after 2 years to assess glucose tolerance and oral β-cell function (oDIcpep) and were sorted into four groups (lean and obese normal glucose tolerance, insulin sensitive, insulin resistant, and impaired glucose tolerance). Insulin sensitivity was defined based on the median of insulin stimulated glucose disposal (M) measured during the hyperinsulinemic-euglycemic clamp. Lean and obese insulin-sensitive participants did not differ with respect to hepatic and peripheral clearance or for insulin sensitivity. Insulin sensitivity was linearly correlated with whole-body insulin clearance. Hepatic insulin extraction at baseline acted as an independent determinant of β-cell function at follow-up. The decline in insulin sensitivity, even in the absence of an impairment of glucose tolerance, is associated with lowering of hepatic insulin clearance in obese youth, which in turn may contribute to the decline in β-cell function over time.
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Affiliation(s)
- Alfonso Galderisi
- Department of Pediatrics, Pediatric Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, CT
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | | | - Ram Weiss
- Department of Pediatrics, Ospedale "SS Annunziata," Chieti, Italy
| | - Cosimo Giannini
- Department of Pediatrics, Pediatric Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, CT
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Bridget Pierpont
- Department of Pediatrics, Pediatric Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, CT
| | - Domenico Tricò
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
- Department of Pediatrics, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Sonia Caprio
- Department of Pediatrics, Pediatric Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, CT
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Kuk JL, Lee S. Sex and Ethnic Differences in the Relationship between Changes in Anthropometric Measurements and Visceral Fat in Adolescents with Obesity. J Pediatr 2019; 213:121-127. [PMID: 31235380 PMCID: PMC6765428 DOI: 10.1016/j.jpeds.2019.05.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine sex and ethnic differences in how baseline and changes in anthropometric measures relate with change in visceral fat with interventions in adolescents. STUDY DESIGN Black and white adolescents (n = 143: body mass index [BMI] ≥85th percentile, 12-18 years) who participated in intervention studies (3-6 months) were included and had assessments of anthropometric measures (weight, BMI, waist circumference, waist-to-hip ratio [WHR], and waist-to-thigh ratio) and visceral fat at L4-L5 by magnetic resonance imaging before and after interventions. RESULTS At baseline, all of the anthropometric measures were positively associated with visceral fat (P < .05), with weight, waist circumference, and WHR having the largest variance explained (model adjusted R2 = 0.35-0.47 vs 0.32-0.35). Blacks had 11.5-23.3 cm2 less visceral fat compared with whites for a given anthropometric value. Girls tended to have less visceral fat for a given anthropometric value, but the sex differences were not consistently significant (range: 0.7-12.9 cm2). Changes in waist circumference, BMI, and weight, but not WHR, remained significantly associated with changes in visceral fat. There were no sex differences, and much more minimal ethnic differences (<4.9 cm2). CONCLUSIONS At baseline, there are sex and ethnic differences in how anthropometric measures correlate with visceral fat. However, there were minimal sex and ethnic differences in how changes in anthropometric measures related with changes in visceral fat. Although all of the anthropometric measures were associated with visceral fat at baseline, waist circumference, BMI, and weight, but not WHR were associated with changes in visceral fat. TRIAL REGISTRATION Clinicaltrials.gov: NCT00739180, NCT01323088, and NCT01938950.
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Affiliation(s)
- Jennifer L. Kuk
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - SoJung Lee
- Division of Sports Medicine, Graduate School of Physical Education, Kyung Hee University, Yongin, Republic of Korea.
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Abstract
PURPOSE OF REVIEW Increased glucose production associated with hepatic insulin resistance contributes to the development of hyperglycemia in T2D. The molecular mechanisms accounting for increased glucose production remain controversial. Our aims were to review recent literature concerning molecular mechanisms regulating glucose production and to discuss these mechanisms in the context of physiological experiments and observations in humans and large animal models. RECENT FINDINGS Genetic intervention studies in rodents demonstrate that insulin can control hepatic glucose production through both direct effects on the liver, and through indirect effects to inhibit adipose tissue lipolysis and limit gluconeogenic substrate delivery. However, recent experiments in canine models indicate that the direct effects of insulin on the liver are dominant over the indirect effects to regulate glucose production. Recent molecular studies have also identified insulin-independent mechanisms by which hepatocytes sense intrahepatic carbohydrate levels to regulate carbohydrate disposal. Dysregulation of hepatic carbohydrate sensing systems may participate in increased glucose production in the development of diabetes.
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Affiliation(s)
- Ashot Sargsyan
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | - Mark A Herman
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA.
- Division of Diabetes, Endocrinology, and Metabolism, Duke University, Durham, NC, USA.
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Abstract
AIM Type 2 diabetes (T2DM) is a complex disease. Interactions between genetic susceptible variants and environmental cues results in the development of this heterogenous disease. Having an understanding of the genetics of T2DM may lead to a better perspective and management of the pathogenesis contributing to T2DM. MATERIALS AND METHODS Published primary and secondary sources were reviewed covering the keywords "genetics + type 2 diabetes" using PubMed and Google Scholar as the main databases. Full articles were considered when the title and the abstract was found to be sufficiently related to the review's aim. RESULTS Various genetic aspects of T2DM were summarised including a general understanding of the heritability and heterogeneity of T2DM. Furthermore, an explanation of the different genetic modalities that can be used to identify T2DM susceptible genes was provided. CONCLUSION In this day and era, researchers and healthcare professionals working in the field of metabolic disorders should have an understanding of T2DM genetics. The future lies in preventive and management action plans targeting the combination of genetics and environmental risk factors for a better health outcome.
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Affiliation(s)
- Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
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Lee S, Park H, Lee Y, Choi O, Kim J, Gray HL, Song K. Relationships between the diabetes awareness and clinical indices/nutrient intakes in Korean adults: Based on the 2012-2013 Korea National Health and Nutrition Examination Survey Data. Nutr Res Pract 2019; 13:240-246. [PMID: 31214292 PMCID: PMC6548712 DOI: 10.4162/nrp.2019.13.3.240] [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: 02/18/2019] [Revised: 03/18/2019] [Accepted: 05/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Diabetes is diagnosed after an average of 10-12 years of diabetic development. Strict glycemic control in diabetic patients promotes the normalization of blood glucose and reduces cardiovascular diseases (CVDs) and diabetic complications. Therefore, early diagnosis in non-aware individuals is very important. SUBJECTS/METHODS Clinical indices and nutrient intakes in Korean diabetic adults aged 19-64 years were examined according to the awareness of diabetes, using 2012 and 2013 Korea National Health and Nutrition Examination Survey (KNHANES) data. The aware group was defined as individuals who were aware of having diabetes from diagnosis by physician before the survey and the non-aware group as individuals who were not aware of having diabetes. RESULTS The average age was higher in the aware group compared to the non-aware group in both men (P = 0.002) and women (P = 0.004). The prevalences of hypertension and dyslipidemia were not different between the two groups, but the diagnosis rate was significantly lower in the non-aware group. In the non-aware group, total and LDL-cholesterol were significantly higher (P < 0.001), the risk for total cholesterol over 240 mg/dL was 3.4 times (95% CI: 1.58-7.52) higher (P = 0.002) and the risk for LDL-cholesterol over 160 mg/dL was 4.59 times (95% CI: 2.07-10.17) higher (P < 0.001). The calorie intake of the female non-aware group was significantly higher compared to the female aware group (P = 0.033). CONCLUSION The results suggested that the recommendation of screening test is necessary even for young adults. Studies on the methodology for early diagnosis of diabetes are also needed.
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Affiliation(s)
- Seul Lee
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Haeryun Park
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Youngmi Lee
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Onjeong Choi
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Jiwon Kim
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Heewon L Gray
- Department of Community and Family Health, University of South Florida 13201, Florida, USA
| | - Kyunghee Song
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
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Nouws J, Fitch M, Mata M, Santoro N, Galuppo B, Kursawe R, Narayan D, Vash-Margita A, Pierpont B, Shulman GI, Hellerstein M, Caprio S. Altered In Vivo Lipid Fluxes and Cell Dynamics in Subcutaneous Adipose Tissues Are Associated With the Unfavorable Pattern of Fat Distribution in Obese Adolescent Girls. Diabetes 2019; 68:1168-1177. [PMID: 30936147 PMCID: PMC6610014 DOI: 10.2337/db18-1162] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/24/2019] [Indexed: 12/20/2022]
Abstract
Patterns of abdominal fat distribution (for example, a high vs. low visceral adipose tissue [VAT]/[VAT + subcutaneous adipose tissue (SAT)] ratio), independent of obesity, during adolescence carry a high risk for insulin resistance and type 2 diabetes. Longitudinal follow-up of a cohort of obese adolescents has recently revealed that a high ratio (high VAT/[VAT + SAT]) is a major determinant of fatty liver and metabolic impairment over time, with these effects being more pronounced in girls than in boys. To unravel the underlying metabolic alterations associated with the unfavorable VAT/(VAT + SAT) phenotype, we used the 2H2O labeling method to measure the turnover of adipose lipids and cells in the subcutaneous abdominal and gluteal/femoral adipose tissue (SAT) of weight-stable obese adolescent girls with a similar level of obesity but discordant VAT/(VAT + SAT) ratios. Girls with the unfavorable (high VAT/[VAT + SAT]) phenotype exhibited higher in vivo rates of triglyceride (TG) turnover (representing both lipolysis and synthesis at steady state), without significant differences in de novo lipogenesis in both abdominal and gluteal depots, compared with obese girls with the favorable phenotype. Moreover, mature adipocytes had higher turnover, with no difference in stromal vascular cell proliferation in both depots in the metabolically unfavorable phenotype. The higher TG turnover rates were significantly correlated with higher intrahepatic fat stores. These findings are contrary to the hypothesis that impaired capacity to deposit TGs or proliferation of new mature adipocytes are potential mechanisms for ectopic fat distribution in this setting. In summary, these results suggest that increased turnover of TGs (lipolysis) and of mature adipocytes in both abdominal and gluteal SAT may contribute to metabolic impairment and the development of fatty liver, even at this very early stage of disease.
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Affiliation(s)
- Jessica Nouws
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Mark Fitch
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA
| | - Mariana Mata
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Nicola Santoro
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Brittany Galuppo
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Romy Kursawe
- Diabetes and Obesity, The Jackson Laboratory, Farmington, CT
| | - Deepak Narayan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Bridget Pierpont
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Gerald I Shulman
- Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
- Department of Cellular and Molecular Physiology, Yale University, New Haven, CT
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA
| | - Sonia Caprio
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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López-Alarcón M, Inda-Icaza P, Márquez-Maldonado MC, Armenta-Álvarez A, Barbosa-Cortés L, Maldonado-Hernández J, Piña-Aguero M, Barradas-Vázquez A, Núñez-García BA, Rodríguez-Cruz M, Fernández JR. A randomized control trial of the impact of LCPUFA-ω3 supplementation on body weight and insulin resistance in pubertal children with obesity. Pediatr Obes 2019; 14:e12499. [PMID: 30590877 PMCID: PMC8513132 DOI: 10.1111/ijpo.12499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 11/16/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Paediatric obesity and insulin resistance (IR) are potentially reversible inflammatory conditions. Long chain polyunsaturated fatty acids omega-3 (LCPUFA-ω3) show anti-inflammatory and metabolic properties, but their clinical efficacy is unclear. OBJECTIVE The objective of this study is to evaluate whether supplementation with LCPUFA-ω3 for 3 months reduces insulin resistance and weight to adolescents with obesity. METHODS Double-blind trial of 366 adolescents with obesity randomly assigned to 1.2-g LCPUFA-ω3 (DO3) or 1-g sunflower oil (DP) daily for 3 months; both groups received an energy-restricted diet. Children attended monthly for anthropometric, dietary, and clinical measurements. Basal and final blood samples were obtained to measure metabolic markers and erythrocytes fatty acids. Regression models were used for analysis. RESULTS A total of 119 DO3 and 126 DP children completed follow-up. At baseline, 92% of children presented IR, 66% hypertriglyceridemia, 37% low-grade inflammation, and 32% metabolic syndrome. Despite erythrocytes LCPUFA-ω3 increased more in DO3 (Median differences = 0.984 w/w%; 95 IC = 0.47, 1.53, P < 0.001), body weight, insulin, and HOMA changed similarly in both groups at the end of intervention. Adjusting for basal values, changes in weight, insulin, and HOMA was not related with supplementation. CONCLUSIONS Supplementation with LCPUFA-ω3 does not affect body weight or insulin in adolescents with obesity.
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Affiliation(s)
- M. López-Alarcón
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - P. Inda-Icaza
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico,Facultad de Ciencias de la Salud, Universidad Anáhuac, Anahuac, Mexico
| | - M. C. Márquez-Maldonado
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - A. Armenta-Álvarez
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - L. Barbosa-Cortés
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - J. Maldonado-Hernández
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - M. Piña-Aguero
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - A. Barradas-Vázquez
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - B. A. Núñez-García
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - M. Rodríguez-Cruz
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - J. R. Fernández
- Department of Nutrition Sciences and Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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42
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Sadananthan SA, Tint MT, Michael N, Aris IM, Loy SL, Lee KJ, Shek LPC, Yap FKP, Tan KH, Godfrey KM, Leow MKS, Lee YS, Kramer MS, Gluckman PD, Chong YS, Karnani N, Henry CJ, Fortier MV, Velan SS. Association Between Early Life Weight Gain and Abdominal Fat Partitioning at 4.5 Years is Sex, Ethnicity, and Age Dependent. Obesity (Silver Spring) 2019; 27:470-478. [PMID: 30707510 PMCID: PMC6392178 DOI: 10.1002/oby.22408] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/28/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the independent associations between age-specific annual weight gain from birth to age 4 years and fat deposition in metabolically distinct compartments at age 4.5 years in a South Asian longitudinal birth cohort. METHODS Volumetric abdominal magnetic resonance imaging with comprehensive segmentation of deep and superficial subcutaneous adipose tissue (SAT) and visceral adipose tissues (VAT) was performed in 316 children (150 boys and 166 girls in three ethnic groups; 158 Chinese, 94 Malay, and 64 Indian) aged 4.5 years. Associations between fat volumes and annual relative weight gain conditional on past growth were assessed overall and stratified by sex and ethnicity. RESULTS Conditional relative weight gain had stronger associations with greater SAT and VAT at age 4.5 years in girls than boys and in Indians compared with Malay and Chinese. Overall, the magnitude of association was the largest during 2 to 3 years for SAT and 1 to 2 years for VAT. Despite similar body weight, Indian children and girls had the highest deep and superficial SAT volumes at age 4.5 years (all interactions P < 0.05). No significant sex or ethnic differences were observed in VAT. With increasing BMI, Indian children had the highest tendency to accumulate VAT, and girls accumulated more fat than boys in all depots (all interactions P < 0.001). CONCLUSIONS Indian ethnicity and female sex predisposed children to accumulate more fat in the VAT depot with increasing conditional relative weight gain in the second year of life. Thus, 1 to 2 years of age may be a critical window for interventions to reduce visceral fat accumulation.
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Affiliation(s)
- Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Kuan Jin Lee
- Singapore BioImaging Consortium, Agency for Science Technology and Research, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Kok Peng Yap
- Duke-NUS Medical School, Singapore
- Department of Paediatric Endocrinology, KK Women’s and Children’s Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore
- Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Melvin Khee-Shing Leow
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science Technology and Research and National University Health System, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael S. Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science Technology and Research and National University Health System, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marielle Valerie Fortier
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - S. Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
- Singapore BioImaging Consortium, Agency for Science Technology and Research, Singapore
- Corresponding author: S. Sendhil Velan, Singapore Institute for Clinical Sciences and Singapore Bioimaging Consortium, 11 Biopolis Way, #02-02, Singapore 138667. Phone: +65 64788757,
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43
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Kim SN, Kim J. Higher Appendicular Skeletal Muscle Mass Protects Metabolically Healthy Obese Boys but Not Girls from Cardiometabolic Abnormality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040652. [PMID: 30813304 PMCID: PMC6406233 DOI: 10.3390/ijerph16040652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 12/11/2022]
Abstract
Factors related to metabolically healthy obesity (MHO) are not well characterized in adolescents. The study’s aim was to investigate the impact of skeletal muscle mass (SMM) on MHO in adolescents. A secondary analysis was performed using the data of 221 Korean overweight and obese adolescents aged 12–18 years from the Korean National Health and Nutrition Examination Survey. Appendicular skeletal muscle (ASM) mass and total body fat mass were measured by dual-energy X-ray absorptiometry. Being metabolically unhealthy was defined using three definitions: Having ≥1, ≥2, or ≥3 cardiometabolic risk factors (CRFs; waist circumference, blood pressure, glucose, triglycerides, and HDL-cholesterol). Multiple logistic regression analyses adjusted for age and lifestyle factors were performed to assess the association between ASM and MHO. In boys, the risk for having either ≥2 CRFs or ≥3 CRFs was significantly lower with higher weight-adjusted ASM and ratio of ASM to fat mass after controlling for covariates, but this association was not significant with CRFs ≥ 1. In girls, all adjusted odds ratios were not significant. Findings indicate that SMM is a potentially protective factor against cardiometabolic abnormality in adolescents with MHO, showing gender difference. This heightens the importance of SMM in the management of obesity, especially in boys.
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Affiliation(s)
- Seung-Nam Kim
- College of Korean Medicine, Dongguk University, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326, Korea.
| | - Jaehee Kim
- Graduate School of Alternative Medicine, Kyonggi University, 63, Kyonggidae-ro 9-gil, Seodaemun-gu, Seoul 120-837, Korea.
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44
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Rashid CS, Bansal A, Simmons RA. Oxidative Stress, Intrauterine Growth Restriction, and Developmental Programming of Type 2 Diabetes. Physiology (Bethesda) 2019; 33:348-359. [PMID: 30109821 DOI: 10.1152/physiol.00023.2018] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intrauterine growth restriction (IUGR) leads to reduced birth weight and the development of metabolic diseases such as Type 2 diabetes in adulthood. Mitochondria dysfunction and oxidative stress are commonly found in key tissues (pancreatic islets, liver, and skeletal muscle) of IUGR individuals. In this review, we explore the role of oxidative stress in IUGR-associated diabetes etiology.
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Affiliation(s)
- Cetewayo S Rashid
- Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Amita Bansal
- Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Rebecca A Simmons
- Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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45
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Cree-Green M, Wiromrat P, Stuppy JJ, Thurston J, Bergman BC, Baumgartner AD, Bacon S, Scherzinger A, Pyle L, Nadeau KJ. Youth with type 2 diabetes have hepatic, peripheral, and adipose insulin resistance. Am J Physiol Endocrinol Metab 2019; 316:E186-E195. [PMID: 30562061 PMCID: PMC6397366 DOI: 10.1152/ajpendo.00258.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Adolescents with type 2 diabetes (T2D) have severe insulin resistance (IR) secondary to obesity, genetics, and puberty, and IR predicts metabolic comorbidities. Adults with T2D have multitissue IR, which has guided therapeutic developments, but this is not established in youth. We sought to assess adipose, hepatic, and peripheral insulin sensitivity in adolescents with and without T2D. Twenty-seven youth with T2D [age: 15.6 ± 0.4 yr; female: 78%; body mass index (BMI) percentile: 96.1 (52.6, 95.9), late puberty; hemoglobin A1c (HbA1c) 7.3% (6.2, 10.1)] and 21 controls of similar BMI, pubertal stage, and habitual activity were enrolled. Insulin action was measured with a four-phase hyperinsulinemic-euglycemic clamp (basal, 10, 16, and 80 mU·m-2·min-1 for studying adipose, hepatic, and peripheral IR, respectively) with glucose and glycerol isotope tracers. Total fat mass, fat-free mass, liver fat fraction, and visceral fat were measured with dual-energy x-ray absorptiometry (DXA) and MRI, respectively. Free fatty acids (FFAs), lipid profile, and inflammatory markers were also measured. Adolescents with T2D had higher lipolysis ( P = 0.012), endogenous glucose production ( P < 0.0001), and lower glucose clearance ( P = 0.002) during hyperinsulinemia than controls. In T2D, peripheral IR positively correlated to FFA ( P < 0.001), inflammatory markers, visceral ( P = 0.004) and hepatic fat ( P = 0.007); hepatic IR correlated with central obesity ( P = 0.004) and adipose IR ( P = 0.003). Youth with T2D have profound multitissue IR compared with BMI-equivalent youth without T2D. The development of multitissue interactions appears crucial to the pathogenesis of T2D. Therapeutic targets on multitissue IR may be of benefit, deserving of further research.
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Affiliation(s)
- Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Pattara Wiromrat
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Jacob J Stuppy
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
- Department of Biomedical Sciences and Biotechnology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Jessica Thurston
- Department of Biostatistics and Informatics, Colorado School of Public Health , Aurora, Colorado
| | - Bryan C Bergman
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Amy D Baumgartner
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Samantha Bacon
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Ann Scherzinger
- Department of Radiology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health , Aurora, Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus , Aurora, Colorado
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46
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Friedman DN, Tonorezos ES, Cohen P. Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer. Horm Res Paediatr 2019; 91:118-127. [PMID: 30650414 PMCID: PMC6610586 DOI: 10.1159/000495698] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/21/2018] [Indexed: 12/15/2022] Open
Abstract
Endocrine complications, including diabetes and metabolic syndrome, are highly prevalent in childhood cancer survivors. These metabolic derangements may contribute to survivors' risk of excess cardiovascular morbidity and premature mortality. This review summarizes existing knowledge on risk of diabetes and metabolic syndrome among childhood cancer survivors, focusing specifically on known risk factors, potential mechanisms, and screening recommendations. Early diagnosis via standardized risk-based screening can improve long-term outcomes in this population. Additional work is needed to elucidate the mechanisms underlying these metabolic complications and to inform the design of risk-reducing interventions and optimize long-term cardiometabolic health among survivors of childhood cancer.
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Affiliation(s)
| | - Emily S. Tonorezos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Paul Cohen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States,Laboratory of Molecular Metabolism, The Rockefeller University, New York, New York, United States
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47
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Nakiriba R, Mayega RW, Piloya T, Nabukeera-Barungi N, Idro R. Prevalence and factors associated with dysglycemia among girls in selected boarding secondary schools in Wakiso District, Uganda. Adolesc Health Med Ther 2018; 9:167-176. [PMID: 30464672 PMCID: PMC6211585 DOI: 10.2147/ahmt.s178746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is limited information on dysglycemia in adolescents in low-income countries. The objective of this study was to determine the prevalence and factors associated with dysglycemia among boarding secondary school adolescent girls in a peri-urban district. METHODS The design was a cross-sectional survey. A total of 688 adolescents from four randomly selected girls-only boarding secondary schools in Wakiso District, Uganda, participated in this study. Fasting plasma glucose, body mass index (BMI), and blood pressure (BP) were measured. A questionnaire was used to assess demographic and lifestyle factors. Suspected dysglycemia was defined using the American Diabetes Association cutoff of fasting glucose ≥5.6 mmol/L. Overweight and hypertension were defined being above two SDs or the 95th percentile of the WHO BMI for age and BP for age reference charts, respectively. Logistic regression was used to determine the factors independently associated with dysglycemia. RESULTS The mean age of the participants was 15.4 years (SD=1.7 years). Probable dysglycemia was found in 44 of 688 (6.4%) participants, ranging from 3.5% in the least affluent school to 9.8% in the most affluent school. No case of type 2 diabetes was found. 11.6% of the participants were found to have probable hypertension. Dysglycemia was higher in adolescents who were overweight (adjusted OR [AOR] 2.3; 95% CI 1.22-4.48), those with hypertension (AOR 4.0; 95% CI 1.86-8.45), and those who frequently stocked biscuits (AOR 3.0; 95% CI 1.21-7.28). Dysglycemia was lower in older adolescents (AOR 0.3; 95% CI 0.10-0.86) and those who took water with meals (AOR 3.0; 95% CI 1.21-7.28). CONCLUSION In these predominantly peri-urban boarding secondary schools, 6.4% of the adolescent girls have probable dysglycemia. As Africa undergoes the epidemiological transition, there is a need for closer surveillance for diabetes and hypertension in peri-urban schools and school health measures against lifestyle diseases.
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Affiliation(s)
- Rhoda Nakiriba
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda,
| | - Thereza Piloya
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Idro
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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48
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Umano GR, Shabanova V, Pierpont B, Mata M, Nouws J, Tricò D, Galderisi A, Santoro N, Caprio S. A low visceral fat proportion, independent of total body fat mass, protects obese adolescent girls against fatty liver and glucose dysregulation: a longitudinal study. Int J Obes (Lond) 2018; 43:673-682. [PMID: 30337653 DOI: 10.1038/s41366-018-0227-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The relative proportion of visceral fat (VAT) to subcutaneous fat (SAT) has been described as a major determinant of insulin resistance (IR). Our study sought to evaluate the effect of body fat distribution on glucose metabolism and intrahepatic fat content over time in a multiethnic cohort of obese adolescents. SUBJECTS/METHODS We examined markers of glucose metabolism by oral glucose tolerance test, and body fat distribution by abdominal MRI at baseline and after 19.2 ± 11.4 months in a cohort of 151 obese adolescents (88 girls, 63 boys; mean age 13.3 ± 3.4 years; mean BMI z-score 2.15 ± 0.70). Hepatic fat content was assessed by fast-gradient MRI in a subset of 93 subjects. We used the median value of VAT/(VAT + SAT) ratio within each gender at baseline to stratify our sample into high and low ratio groups (median value 0.0972 in girls and 0.118 in boys). RESULTS Female subjects tended to remain in their VAT/(VAT + SAT) category over time (change over follow-up P = 0.14 among girls, and P = 0.04 among boys). Baseline VAT/(VAT + SAT) strongly predicted the hepatic fat content, fasting insulin, 2-h glucose, and whole-body insulin sensitivity index at follow-up among girls, but not in boys. CONCLUSIONS The VAT/(VAT + SAT) ratio is a major determinant of impaired glucose metabolism and hepatic fat accumulation over time, and its effects are more pronounced in girls than in boys.
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Affiliation(s)
- Giuseppina R Umano
- Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of the Woman, the Child, of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Bridget Pierpont
- Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Mariana Mata
- Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Jessica Nouws
- Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Domenico Tricò
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alfonso Galderisi
- Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Nicola Santoro
- Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Sonia Caprio
- Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT, 06520, USA.
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Sánchez-Cruz JJ, de Ruiter I, Jiménez-Moleón JJ, García L, Sánchez MJ. Stabilization and reversal of child obesity in Andalusia using objective anthropometric measures by socioeconomic status. BMC Pediatr 2018; 18:322. [PMID: 30309338 PMCID: PMC6180603 DOI: 10.1186/s12887-018-1295-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 10/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood obesity continues to be a significant public health issue worldwide. Recent national studies in Spain show a stable picture. However, prevalence and trends differ by socio-economic status, age, and region. We present the trend in childhood excess weight prevalence, aged 8-15 years, in Andalusia from 2011-2012 to 2015-2016 by socio-economic status. METHODS Using the cross-sectional Andalusian Health Surveys, objective anthropometric measures were taken for a representative sample of 8-15 year olds in Andalusia in 2011-2012 and 2015-2016. Prevalence and changes in prevalence of excess weight (overweight plus obesity) were calculated, using both the WHO and IOTF criteria, overall and for sex, age and three different indicators of SES. RESULTS Overall prevalence of excess weight decreased from 42.0% in 2011-2012 to 35.4% in 2015-2016. Overweight decreased from 28.2 to 24.2% and obesity from 13.8 to 11.2%. In 2011-2012 the prevalence of excess weight in boys was 46.0%and 37.9% in girls; in 2015-2016 the difference became significant with 41% of boys with excess weight compared with 30% in girls. CONCLUSIONS Childhood excess weight prevalence in Andalusia has decreased slightly between 2011-2012 and 2015-2016. Notably, a decrease in obesity prevalence in girls aged 8-15 years was recorded. In 2011-2012 a social gradient for excess weight prevalence across three SES indicators was observed: in 2015-2016 this gradient disappeared. Nonetheless, prevalence remains too high.
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Affiliation(s)
- José-Juan Sánchez-Cruz
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - I de Ruiter
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
| | - J J Jiménez-Moleón
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Ll García
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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50
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Cree-Green M, Stuppy JJ, Thurston J, Bergman BC, Coe GV, Baumgartner AD, Bacon S, Scherzinger A, Pyle L, Nadeau KJ. Youth With Type 1 Diabetes Have Adipose, Hepatic, and Peripheral Insulin Resistance. J Clin Endocrinol Metab 2018; 103:3647-3657. [PMID: 30020457 PMCID: PMC6179173 DOI: 10.1210/jc.2018-00433] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Adolescents with type 1 diabetes (T1D) have difficulty obtaining optimal glucose control, which may relate to insulin resistance (IR), especially during puberty. Moreover, IR increases the risk for cardiovascular disease, the leading cause of death in T1D. However, the tissue specificity of IR in adolescents with T1D has not been fully phenotyped. OBJECTIVE To assess adipose, hepatic, and peripheral insulin sensitivity in adolescents with and without T1D. DESIGN AND SETTING Thirty-five youth with T1D [median age, 16 (first and third quartiles, 14, 17) years; 53% female; median body mass index (BMI) percentile, 82nd (55th, 96th); late puberty; median hemoglobin A1c, 8.3% (7.3%, 9.4%)] and 22 nondiabetic youth of similar age, BMI, pubertal stage, and level of habitual physical activity were enrolled. Insulin action was measured with a four-phase hyperinsulinemic euglycemic clamp (basal and 10, 16, and 80 mU/m2/min) with glucose and glycerol isotope tracers. RESULTS Adolescents with T1D had a significantly higher rate of lipolysis (P < 0.0001) and endogenous glucose production (P < 0.001) and lower peripheral glucose uptake (glucose rate of disappearance, 6.9 ± 2.9 mg/kg/min for patients with T1D vs 11.3 ± 3.3 for controls; P < 0.0001) during hyperinsulinemia compared with controls. In youth with T1D, glucose rate of disappearance correlated with free fatty acid at the 80-mU/m2/min phase (P = 0.005), markers of inflammation (IL-6; P = 0.012), high-sensitivity C-reactive protein (P = 0.001), and leptin (P = 0.008)], but not hemoglobin A1c. CONCLUSIONS Adolescents with T1D have adipose, hepatic and peripheral IR. This IR occurs regardless of obesity and metabolic syndrome features. Youth with T1D may benefit from interventions directed at improving IR in these tissues, and this area requires further research.
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Affiliation(s)
- Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Correspondence and Reprint Requests: Melanie Cree-Green, MD, PhD, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, P.O. Box 265, 13123 East 16th Avenue, Aurora, Colorado 80045. E-mail:
| | - Jacob J Stuppy
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Biomedical Sciences and Biotechnology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica Thurston
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Bryan C Bergman
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gregory V Coe
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amy D Baumgartner
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samantha Bacon
- Department of Medicine, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ann Scherzinger
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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