Change in daily energy intake associated with pairwise compositional change in carbohydrate, fat and protein intake among US adults, 1999-2010

Obesity in Type 1 Diabetes: Pathophysiology, Clinical Impact, and Mechanisms

There has been an alarming increase in the prevalence of obesity in people with type 1 diabetes in recent years. Although obesity has long been recognized as a major risk factor for the development of type 2 diabetes and a catalyst for complications, much less is known about the role of obesity in the initiation and pathogenesis of type 1 diabetes. Emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes. Unique therapeutic strategies may be required to address these comorbidities within the context of intensive insulin therapy, which promotes weight gain. There is an urgent need for clinical guidelines for the prevention and management of obesity in type 1 diabetes. The development of these recommendations will require a transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics. In this review, the prevalence, clinical impact, energy balance physiology, and potential mechanisms of obesity in type 1 diabetes are described, with a special focus on the substantial gaps in knowledge in this field. Our goal is to provide a framework for the evidence base needed to develop type 1 diabetes-specific weight management recommendations that account for the competing outcomes of glycemic control and weight management.

Association Between Walking and Low Back Pain in the Korean Population: A Cross-Sectional Study

Objective

To investigate if walking is independently associated with low back pain (LBP) in the general population.

Methods

This cross-sectional study used public data from the Fourth and Fifth Korean National Health and Nutrition Examination Survey. Subjects included 5,982 community-dwelling adults aged ≥50 years. Presence of current LBP was defined as LBP for 1 month or more in the past 3 months. Walking was measured as total walking duration for the past week and subjects were divided into four quartiles. Independent effect of walking on LBP was determined using odds ratios (OR) adjusted for age, sex, osteoporosis, depression or anxiety, and radiographic lumbar spondylosis.

Results

Prevalence of LBP was 26.4% in this population. Older people and women had higher prevalence of current LBP. Prevalence of obesity and osteoporosis was higher in subjects with current LBP and quality of life was poorer in subjects with current LBP. Adjusted logistic regression model revealed that older age (OR, 1.655; p=0.018), female sex (OR, 2.578; p<0.001), radiographic lumbar spondylosis (OR, 2.728; p<0.001), depression or anxiety (OR, 5.409; p<0.001), and presence of osteoporosis (OR, 1.467; p=0.002) were positively associated with current LBP. Walking decreased prevalence of current LBP proportionally (2nd quartile OR, 0.795; 3rd quartile OR, 0.770; and 4th quartile OR, 0.686 compared with the 1st quartile of walking).

Conclusion

Walking was negatively associated with LBP. Further studies are needed to reveal causal relationship of this phenomenon.

Green Tea Extract Rich in Epigallocatechin-3-Gallate Prevents Fatty Liver by AMPK Activation via LKB1 in Mice Fed a High-Fat Diet

Supplementation with epigallocatechin-3-gallate has been determined to aid in the prevention of obesity. Decaffeinated green tea extract appears to restore a normal hepatic metabolic profile and attenuate high-fat diet (HFD)-induced effects, thereby preventing non-alcoholic fatty liver disease in mice. Mice were maintained on either a control diet (CD) or HFD for 16 weeks and supplemented with either water or green tea extract (50 mg/kg/day). The body mass increase, serum adiponectin level, and lipid profile were measured over the course of the treatment. Furthermore, the AMPK pathway protein expression in the liver was measured. From the fourth week, the weight gain in the CD + green tea extract (CE) group was lower than that in the CD + water (CW) group. From the eighth week, the weight gain in the HFD + water (HFW) group was found to be higher than that in the CW group. Moreover, the weight gain in the HFD + green tea extract (HFE) group was found to be lower than that in the HFW group. Carcass lipid content was found to be higher in the HFW group than that in the CW and HFE groups. Serum analysis showed reduced non-esterified fatty acid level in the CE and HFE groups as compared with their corresponding placebo groups. Increased adiponectin level was observed in the same groups. Increased VLDL-TG secretion was observed in the HFW group as compared with the CW and HFE groups. Increased protein expression of AdipoR2, SIRT1, pLKB1, and pAMPK was observed in the HFE group, which explained the reduced expression of ACC, FAS, SREBP-1, and ChREBP in this group. These results indicate that the effects of decaffeinated green tea extract may be related to the activation of AMPK via LKB1 in the liver of HFD-fed mice.

Decaffeinated green tea extract rich in epigallocatechin-3-gallate prevents fatty liver disease by increased activities of mitochondrial respiratory chain complexes in diet-induced obesity mice

Nonalcoholic fatty liver disease has been considered the hepatic manifestation of obesity. It is unclear whether supplementation with green tea extract rich in epigallocatechin-3-gallate (EGCG) influences the activity of mitochondrial respiratory chain complexes and insulin resistance in the liver. EGCG regulated hepatic mitochondrial respiratory chain complexes and was capable of improving lipid metabolism, attenuating insulin resistance in obese mice. Mice were divided into four groups: control diet+water (CW) or EGCG (CE) and hyperlipidic diet+water (HFW) or EGCG (HFE). All animals received water and diets ad libitum for 16 weeks. Placebo groups received water (0.1 ml/day) and EGCG groups (0.1 ml EGCG and 50 mg/kg/day) by gavage. Cytokines concentrations were obtained by ELISA, protein expression through Western blotting and mitochondrial complex enzymatic activity by colorimetric assay of substrate degradation. HFW increased body weight gain, adiposity index, retroperitoneal and mesenteric adipose tissue relative weight, serum glucose, insulin and Homeostasis Model Assessment of Basal Insulin Resistance (HOMA-IR); glucose intolerance was observed in oral glucose tolerance test (OGTT) as well as ectopic fat liver deposition. HFE group decreased body weight gain, retroperitoneal and mesenteric adipose tissue relative weight, HOMA-IR, insulin levels and liver fat accumulation; increased complexes II-III and IV and malate dehydrogenase activities and improvement in glucose uptake in OGTT and insulin sensitivity by increased protein expression of total AKT, IRα and IRS1. We did not find alterations in inflammatory parameters analyzed. EGCG was able to prevent obesity stimulating the mitochondrial complex chain, increasing energy expenditure, particularly from the oxidation of lipid substrates, thereby contributing to the prevention of hepatic steatosis and improved insulin sensitivity.

A high-protein diet for reducing body fat: mechanisms and possible caveats

High protein diets are increasingly popularized in lay media as a promising strategy for weight loss by providing the twin benefits of improving satiety and decreasing fat mass. Some of the potential mechanisms that account for weight loss associated with high-protein diets involve increased secretion of satiety hormones (GIP, GLP-1), reduced orexigenic hormone secretion (ghrelin), the increased thermic effect of food and protein-induced alterations in gluconeogenesis to improve glucose homeostasis. There are, however, also possible caveats that have to be considered when choosing to consume a high-protein diet. A high intake of branched-chain amino acids in combination with a western diet might exacerbate the development of metabolic disease. A diet high in protein can also pose a significant acid load to the kidneys. Finally, when energy demand is low, excess protein can be converted to glucose (via gluconeogenesis) or ketone bodies and contribute to a positive energy balance, which is undesirable if weight loss is the goal. In this review, we will therefore explore the mechanisms whereby a high-protein diet may exert beneficial effects on whole body metabolism while we also want to present possible caveats associated with the consumption of a high-protein diet.