Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance

A Literature Review and a Proposed Classification of the Relationships between Ovulatory Infertility and Lifestyle Factors Based on the Three Groups of Ovulation Disorders Classified by WHO

Ovulatory infertility is a serious clinical problem whose direct causes are still largely unknown. In addition to pathologies that make it impossible for a couple to establish a pregnancy, there are a number of other factors that have a bearing on fertility, including lifestyle factors, and particularly diet. Although numerous studies have been performed linking such factors to ovulatory infertility, most of them lack the necessary clinical significance, instead focusing on observational data and suggesting or establishing associative relationships. This article consists of a literature review focusing on connections between lifestyle factors such as diet, physical exercise, oxidative stress, sleep, and supplementation, and ovulatory infertility. Special emphasis was given to issues such as obesity and insulin resistance and their mutual relationship with other factors linked to ovulatory infertility. In addition, based on the conclusions of the literature review, the authors have proposed a classification of relationships between ovulation disorders and lifestyle factors in ovulatory infertility within the framework of the WHO classification of ovulation disorders. Furthermore, areas that merit further research have been indicated as well as those that do not. WHO Group II disorders gained prominence in the results of the study as the number of links with lifestyle factors and ovulatory infertility found in the course of the review greatly exceeded those for Groups I and III. The data presented in the article show that the issues of proper diet and physical exercise are those that could benefit from robust clinical studies focused specifically on ovulation infertility, while studies concerning the relationship between oxidative stress, sleep, and supplementation and ovulatory infertility do not seem to be promising directions as far as clinical significance is concerned.

Adipokines as Clinically Relevant Therapeutic Targets in Obesity

Adipokines provide an outstanding role in the comprehensive etiology of obesity and may link adipose tissue dysfunction to further metabolic and cardiovascular complications. Although several adipokines have been identified in terms of their physiological roles, many regulatory circuits remain unclear and translation from experimental studies to clinical applications has yet to occur. Nevertheless, due to their complex metabolic properties, adipokines offer immense potential for their use both as obesity-associated biomarkers and as relevant treatment strategies for overweight, obesity and metabolic comorbidities. To provide an overview of the current clinical use of adipokines, this review summarizes clinical studies investigating the potential of various adipokines with respect to diagnostic and therapeutic treatment strategies for obesity and linked metabolic disorders. Furthermore, an overview of adipokines, for which a potential for clinical use has been demonstrated in experimental studies to date, will be presented. In particular, promising data revealed that fibroblast growth factor (FGF)-19, FGF-21 and leptin offer great potential for future clinical application in the treatment of obesity and related comorbidities. Based on data from animal studies or other clinical applications in addition to obesity, adipokines including adiponectin, vaspin, resistin, chemerin, visfatin, bone morphogenetic protein 7 (BMP-7) and tumor necrosis factor alpha (TNF-α) provide potential for human clinical application.

Long-term effect of intensive lifestyle intervention on cardiometabolic risk factors and microvascular complications in patients with diabetes in real-world clinical practice: a 10-year longitudinal study

INTRODUCTION

Intensive lifestyle intervention (ILI) has significantly reduced incidence of diabetes and improved many cardiovascular disease risk factors. We evaluated long-term effects of ILI on cardiometabolic risk factors, and microvascular and macrovascular complications among patients with diabetes in real-world clinical practice.

RESEARCH DESIGN AND METHODS

We evaluated 129 patients with diabetes and obesity enrolled in a 12-week translational model of ILI. At 1 year, we divided participants into group A, who maintained <7% weight loss (n=61, 47.7%), and group B, who maintained ≥7% weight loss (n=67, 52.3%). We continued to follow them for 10 years.

RESULTS

The total cohort lost an average of 10.8±4.6 kg (-9.7%) at 12 weeks and maintained an average weight loss of 7.7±10 kg (-6.9%) at 10 years. Group A maintained 4.3±9.5 kg (-4.3%) and group B maintained 10.8±9.3 kg (-9.3%) of weight loss at 10 years (p<0.001 between groups). In group A, A1c decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but rebounded to 7.7±1.4% at 1 year and 8.0±1.9% at 10 years. In group B, A1c decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks then increased to 6.8±1.2% at 1 year and 7.3±1.5% at 10 years (p<0.05 between groups). Maintenance of ≥7% weight loss at 1 year was associated with a 68% lower risk of developing nephropathy for up to 10 years compared with maintenance of <7% weight loss (adjusted HR for group B: 0.32, 95% CI 0.11, 0.9, p=0.007).

CONCLUSIONS

Weight reduction in patients with diabetes can be maintained for up to 10 years in real-world clinical practice. Sustained weight loss is associated with significantly lower A1c at 10 years and improvement in lipid profile. Maintenance of ≥7% weight loss at 1 year is associated with decreased incidence of diabetic nephropathy at 10 years.

The Role of Adipokines in Health and Disease

Adipokines are cell-signaling proteins secreted by adipose tissue that has been related to a low-grade state of inflammation and different pathologies. The present review aims to analyze the role of adipokines in health and disease in order to understand the important functions and effects of these cytokines. For this aim, the present review delves into the type of adipocytes and the cytokines produced, as well as their functions; the relations of adipokines in inflammation and different diseases such as cardiovascular, atherosclerosis, mental diseases, metabolic disorders, cancer, and eating behaviors; and finally, the role of microbiota, nutrition, and physical activity in adipokines is discussed. This information would allow for a better understanding of these important cytokines and their effects on body organisms.

Impact of Two Types of Exercise Interventions on Leptin and Omentin Concentrations and Indicators of Lipid and Carbohydrate Metabolism in Males with Metabolic Syndrome

Leptin (LEP) and omentin (OMEN) are proteins whose concentrations change with the development of the metabolic syndrome (MetS). There are few intervention studies using various forms of physical activity in people with MetS that aim to determine the impact of physical exercise on the fluctuations of the presented hormones, and their results are contradictory. The present study aimed to examine the effect of two types of exercise intervention on LEP and OMEN concentrations and indicators of lipid and carbohydrate metabolism in males with MetS. The study included 62 males with MetS (age 36.6 ± 6.9 years, body mass 110.31 ± 17.37 kg), randomly allocated to EG1, the examined group with aerobic training (n = 21); EG2, the examined group with combined aerobic and resistance training (n = 21), both for 12 weeks, and the control group (CG) without interventions (n = 20). Anthropometric measurements, body composition (body fat [BF], android body fat [ANDR]), as well as a biochemical blood analysis (omentin [OMEN], leptin [LEP], quantitative insulin sensitivity check index [QUICKI], high-density lipoprotein cholesterol [HDL-C] and nonHDL-C) were performed at baseline, and at 6 and 12 weeks of interventions and after 4 weeks after ending intervention (follow-up). Intergroup and intragroup comparisons were performed. In the intervention groups EG1 and EG2, a decrease in BF was observed as well as an improvement in carbohydrate metabolism parameters. In the EG1 group, the level of ANDR was reduced. In EG2 a decrease in LEP concentration between measurements was confirmed. However, no significant changes were found in the concentration of OMEN in any groups. Combined aerobic and resistance exercises led to a higher reduction of LEP concentration than applying only aerobic training in males with MetS.

Effect of Renal Denervation on the Plasma Adiponectin Concentration in Patients with Resistant Hypertension

(1) Introduction: Adiponectin is synthetized by white adipose tissue and has anti-diabetic, anti-atherosclerotic, anti-thrombotic, anti-inflammatory, and cardioprotective properties. In patients with arterial hypertension, plasma concentration of adiponectin is lower than in healthy subjects. Renal denervation, i.e., percutaneous ablation of fibers from the sympathetic nervous system located in the wall of the renal arteries by radio frequency waves, is a method of resistant arterial hypertension treatment. (2) The aim of this single center, interventional, clinical study was to assess the effect of renal denervation on the plasma adiponectin concentration in patients with resistant arterial hypertension. (3) Materials and methods: 28 patients (13 women, 15 men) aged 54.4 ± 9.2 years with resistant hypertension who underwent renal denervation using Simplicity catheters (Medtronic, Inc., Northridge, CA, USA) were enrolled in the study. Plasma adiponectin concentration was determined using the Human Adiponectin ELISA Kit (Otsuka Pharmaceutical Co, Tokyo, Japan) before the renal denervation and 6 and 12 months after this procedure. (4) Results: Blood pressure (BP) values before renal denervation and 6 and 12 months after this procedure were as follows: systolic BP 190.4 ± 24.5, 160.8 ± 14.5, 155.7 ± 17.9 mmHg (p < 0.001) and diastolic BP 111.7 ± 18.9, 88.9 ± 8.3, 91.2 + 10.2 mmHg (p < 0.001), respectively. Body mass index (BMI) before renal denervation, 6 and 12 months after this procedure were 31.5 ± 4.2, 30.5 ± 4.4, 30.2 ± 4.0 kg/m2, (p = 0.057), respectively. Plasma adiponectin concentration before the renal denervation and 6 and 12 months after this procedure were 4.79 (3.95; 9.49), 7.58 (5.04; 9.51), 6.62 (4.57; 11.65) [µg/mL] (p = 0.007), respectively. (5) Conclusions: Plasma adiponectin concentration increases significantly after successful renal denervation in patients with resistant hypertension. Higher plasma adiponectin concentration may participate—beyond blood pressure reduction—in the cardiovascular benefits related to successful renal denervation; however’ clinical consequences of these results need further investigations.

Exercise training-induced changes in exerkine concentrations may be relevant to the metabolic control of type 2 diabetes mellitus patients: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

This study investigates the effects of exercise training on exerkines in patients with type 2 diabetes mellitus to determine the optimal exercise prescription.

METHODS

A systematic search for relevant studies was performed in 3 databases. Randomized controlled trials investigating the effects of exercise training on at least one of the following exerkines were included: adiponectin, apelin, brain-derived neurotrophic factor, fetuin-A, fibroblast growth factor-21, follistatin, ghrelin, interleukin (IL)-6, IL-8, IL-10, IL-15, IL-18, leptin, myostatin, omentin, resistin, retinol-binding protein 4, tumor necrosis factor-α, and visfatin.

RESULTS

Forty randomized controlled trials were selected for data extraction (n = 2160). Exercise training induces changes in adiponectin, fetuin-A, fibroblast growth factor-21, IL-6, IL-10, leptin, resistin, and tumor necrosis factor-α levels but has no significant effects on apelin, IL-18, and ghrelin compared to controls. Physical exercise training favored large and positive changes in pooled exerkines (i.e., an overall effect size calculated from several exerkines) (Hedge's g = 1.02, 95% confidence interval (95%CI): 0.76-1.28), which in turn were related to changes in glycated hemoglobin (mean difference (MD) = -0.81%, 95%CI: -0.95% to -0.67%), fasting glucose (MD = -23.43 mg/dL, 95%CI: -30.07 mg/dL to -16.80 mg/dL), waist circumference (MD = -3.04 cm, 95%CI: -4.02 cm to -2.07 cm), and body mass (MD = -1.93 kg, 95%CI: -2.00 kg to -1.86 kg). Slightly stronger effects were observed with aerobic, resistance, or high-intensity interval protocols at moderate- to vigorous-intensity and with programs longer than 24 weeks that comprise at least 3 sessions per week and more than 60 min per session.

CONCLUSION

Exercise training represents an anti-inflammatory therapy and metabolism-improving strategy with minimal side effects for patients with type 2 diabetes mellitus.

Effect of 8 Weeks Aerobic Training and Saffron Supplementation on Inflammation and Metabolism in Middle-Aged Obese Women with Type 2 Diabetes Mellitus

Background: This study aimed to investigate the effects of 8-week aerobic training (AT) and saffron supplementation on inflammation and metabolism in middle-aged obese women with type 2 diabetes mellitus (T2DM). Methods: Thirty-two obese women with T2DM were randomly divided into four groups (n = 8 in all groups): saffron + training (ST), placebo + training (PT), saffron supplementation (SS), and placebo (P). The ST and PT groups performed eight weeks of aerobic training (AT) (three sessions/week at 60−75% HRmax). A daily dose of 400 mg saffron powder was consumed by the ST and SS groups for 8 weeks. Blood samples were taken after 12 h of fasting, 48 h before the first AT session, 48 h and two weeks after the last AT session. Results: AT, saffron supplementation, and their combination affected body mass index (BMI), homeostatic model assessment for insulin resistance (HOMA-IR), and serum levels of insulin, adiponectin, interleukin-6 (IL-6), high-density lipoprotein cholesterol (HDL-C), cholesterol, and triglyceride (TG) (p < 0.05). However, body weight, body fat percentage, and serum levels of glucose, resistin, tumor necrosis factor-alpha (TNF-α), irisin, and low-density lipoprotein cholesterol (LDL-C) showed significant changes in the ST group only (p < 0.05). In addition, a significant difference was seen between all factors in post-training and follow-up in the ST group (p < 0.05). Conclusions: Saffron supplementation at a dose of 400 mg/day, when combined with AT, could improve inflammation, metabolism, glycemic status, and lipid profile in T2DM patients, and these changes are sustainable at up to 2 weeks of detraining.

Increased Secreted Frizzled-Related Protein 5 mRNA Expression in the Adipose Tissue of Women with Nonalcoholic Fatty Liver Disease Associated with Obesity

Secreted frizzled-related protein 5 (SFRP5) is an anti-inflammatory adipocytokine secreted by adipocytes that seems to be linked with nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the role of the SFRP5-wingless-MMTV integration site family member 5a (WNT5A) pathway, closely related to adipogenesis, in subcutaneous (SAT) and visceral adipose tissues (VAT) and its relationship with obesity-related NAFLD. Our cohort was composed of 60 women with morbid obesity (MO), who underwent hypocaloric diet, subclassified according to their hepatic histopathology and 15 women with normal weight. We observed increased SFRP5 mRNA expression in VAT and lower WNT5A expression in SAT in MO compared to normal weight. We found elevated SFRP5 expression in nonalcoholic steatohepatitis (NASH) in SAT and in mild simple steatosis (SS) and NASH in VAT. We observed higher WNT5A expression in SS compared to normal liver in SAT, and a peak of WNT5A expression in mild SS. To conclude, we reported increased SFRP5 mRNA expression in SAT and VAT of NAFLD-related to obesity subjects, suggesting an implication of the SFRP5-WNT5A pathway in NAFLD pathogenesis, probably due to the adipose tissue-liver axis. Since the mechanisms by which this potential interaction takes place remain elusive, more research in this field is needed.

Improved Aerobic Capacity and Adipokine Profile Together with Weight Loss Improve Glycemic Control without Changes in Skeletal Muscle GLUT-4 Gene Expression in Middle-Aged Subjects with Impaired Glucose Tolerance

(1) Objective: The aim of this study was to clarify the role of adipokines in the regulation of glucose metabolism in middle-aged obese subjects with impaired glucose tolerance in response to a long-term exercise and dietary intervention. (2) Methods: Skeletal muscle, plasma and serum samples were examined in 22 subjects from an exercise−diet intervention study aiming to prevent type 2 diabetes. The subjects were further divided into two subgroups (non-responders n = 9 and responders n = 13) based on their achievement in losing at least 3 kg. (3) Results: The two-year exercise−diet intervention reduced leptin levels and increased adiponectin levels in responders; the changes in leptin levels were significantly associated with changes in their weights (r = 0.662, p < 0.01). In responders, insulin sensitivity (Bennett and McAuley index) increased and was associated with changes in maximal oxygen uptake (VO2peak) (r = 0.831, p < 0.010 and r = 0.890, p < 0.01). In addition, the VO2peak and oxidative capacity of skeletal muscle improved in responders, but not in non-responders. However, there were no changes between the two groups in expressions of the glucose transporter protein-4 (GLUT-4) gene or of AMP-activated protein kinase (AMPK)-α1 or AMPK-α2 proteins. (4) Conclusions: The exercise−diet intervention decreased serum leptin and increased serum adiponectin concentrations, improved glucose control without affecting GLUT-4 gene expression in the skeletal muscle in responders.

Impact of Physical Activity on Adiposity and Risk Markers for Cardiovascular and Metabolic Disease

The main aim of the present study was to investigate the impact of physical activity (PA) on adiposity and for cardiovascular and metabolic disease risk markers (CMDRMs). In total, 55 adults (33 lean [L] and 22 overweight/obesity [O/O]) visited the laboratory on two occasions. During the first session, body composition and anthropometric measurements were taken as well as resting blood pressure (BP). Free-living PA intensity was monitored using an ActiGraph accelerometer, which the participants wore for a period of 6 days. During the second visit, blood samples for the analysis of disease risk markers were obtained from the participants in the morning after overnight fasting (≥10 hr). There was no significant difference between groups in the percentage of time spent in PA levels (54.5% ± 1.2% and 54.9% ± 2.1% for L and O/O, respectively). Although, the O/O group was within recommended PA level, they had higher leptin, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein (hsCRP) levels than the L group (all p < .01). The O/O group had higher levels of triglycerides, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) and lower levels of high-density lipoprotein (HDL; all p < .01). Interestingly, vigorous activity was positively correlated with HDL (r = .30, p < .05) and negatively with LDL (r = -.26, p = .05) levels and the arachidonic acid to eicosapentaenoic acid (ARA/EPA) ratio (r = -.30, p < .05). Only the O/O group had elevated CMDRMs. However, vigorous activity may improve health-related blood lipids such as HDL, LDL, and ARA/EPA ratio. Regardless of body composition status, low active participants were more likely to have higher level of leptin and hsCRP. Further exploration of the beneficial effects of vigorous exercise on adiposity and CMDRMs is warranted.

Short-Term and Lifelong Exercise Training Lowers Inflammatory Mediators in Older Men

Increased basal low-grade inflammation is observed with advancing age, which is augmented by physical inactivity. However, data regarding the influence of lifelong exercise training and particularly high-intensity interval training (HIIT) on inflammatory mediators in older men are scarce. Therefore, we examined effects of 6weeks of aerobic preconditioning followed by 6weeks of HIIT on inflammatory mediators [interleukin (IL)-6, homocysteine, and high-sensitivity C-reactive protein (hsCRP)] in previously sedentary older men (SED) and masters athletes (LEX). Further, we investigated whether SED exhibited greater basal inflammatory biomarkers compared to LEX. Twenty-two men (aged 62±2years) participated in the SED group, while 17 age-matched LEX men (aged 60±5years) also participated as a positive comparison group. In SED, preconditioning (P=0.030, d=0.34) and HIIT (P=0.030, d=0.48) caused a reduction in IL-6 compared to enrollment. SED homocysteine did not change throughout (P>0.57; d<0.26), while the decrease in hsCRP after preconditioning (P=0.486, d=0.25) and after HIIT (P=0.781, d=0.23) compared to enrollment was small. HIIT did not influence IL-6 or hsCRP in LEX (all P>0.42; d<0.3). Homocysteine increased from enrollment to post-HIIT in LEX (P=0.144, d=0.83), but all other perturbations were trivial. IL-6 and hsCRP were greater in SED than LEX throughout the investigation (all P<0.029; d>0.72), but homocysteine was not different (all P >0.131; d<0.41). Results of this study suggest moderate-intensity aerobic exercise and HIIT lowers IL-6 (and possible hsCRP) in previously sedentary older men. Moreover, lifelong exercise is associated with reduced concentrations of some inflammatory biomarkers in older males, and therefore, physical activity, rather than age per se, is implicated in chronic low-grade inflammation. Moreover, physical inactivity-induced inflammation may be partly salvaged by short-term exercise training.

A Systematic Review and Meta-Analysis of the Impact of Different Intensity of Dietary Counselling on Cardiometabolic Health in Middle-Aged and Older Adults

Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): −0.24 mmol/L, 95% confidence intervals (CIs): −0.40 to −0.09), TC (WMD: −0.31 mmol/L, 95% CIs: −0.49 to −0.13), LDL (WMD: −0.39 mmol/L, 95% CIs: −0.61 to −0.16) and FBS (WMD: −0.69 mmol/L, 95% CIs: −0.99 to −0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.

Complex Exercise Improves Anti-Inflammatory and Anabolic Effects in Osteoarthritis-Induced Sarcopenia in Elderly Women

We investigated the effects of a 15-week complex exercise program on osteoarthritis and sarcopenia by analyzing anabolic effects and the impact on the activities of daily living (ADLs). Nineteen women aged ≥60 years with sarcopenia (SEG, n = 9) or diagnosed with osteoarthritis with sarcopenia (OSEG, n = 10) were enrolled and underwent an exercise program. Insulin-like growth factor 1 (IGF-1), irisin, myostatin, interleukin-10 (IL-10), and tumor necrosis factor alpha (TNF-a) levels were analyzed pre- and post-intervention. Thigh cross-sectional area (TCSA) was measured pre- and post-intervention via computed tomography. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Physical Performance Battery (SPBB) were assessed pre- and post-interventions to assess ADL. There was a significant interaction effect between SEG and OSEG at the IGF-1 level post-intervention. Irisin increased and myostatin decreased post-intervention in both groups. IL-10 increased and TNF-α decreased post-intervention with a significant interaction effect in the OSEG group. TCSAs increased post-intervention in both groups. There was a significant interaction between the two groups. OSEG showed a greater WOMAC decrease and SPPB increase post-intervention, and there was a significant interaction effect. Combined exercise may be effective in improving biochemical factors, anabolic effects, and ADL in elderly women with osteoarthritis and sarcopenia.

Circulating adiponectin mediates the association between omentin gene polymorphism and cardiometabolic health in Asian Indians

BACKGROUND

Plasma omentin levels have been shown to be associated with circulating adiponectin concentrations and cardiometabolic disease-related outcomes. In this study, we aim to examine the association of omentin gene polymorphism with serum adiponectin levels and cardiometabolic health status using a genetic approach, and investigate whether these associations are modified by lifestyle factors.

METHODS

The study included 945 normal glucose tolerant and 941 unrelated individuals with type 2 diabetes randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), in southern India. Study participants were classified into cardiometabolically healthy and unhealthy, where cardiometabolically healthy were those without hypertension, diabetes, and dyslipidemia. Fasting serum adiponectin levels were measured by radioimmunoassay. The omentin A326T (rs2274907) single nucleotide polymorphism (SNP) was screened by polymerase chain reaction-restriction fragment length polymorphism and direct sequencing.

RESULTS

The 'A' allele of the omentin SNP was significantly associated with lower adiponectin concentrations after adjusting for age, sex, body mass index (BMI), waist circumference (WC) and cardiometabolic health status (p = 1.90 x 10-47). There was also a significant association between circulating adiponectin concentrations and cardiometabolic health status after adjusting for age, sex, BMI, WC and Omentin SNP (p = 7.47x10-10). However, after adjusting for age, sex, BMI, WC and adiponectin levels, the association of 'A' allele with cardiometabolic health status disappeared (p = 0.79) suggesting that adiponectin serves as a mediator of the association between omentin SNP and cardiometabolic health status. There were no significant interactions between the SNP and dietary factors on adiponectin levels and cardiometabolic health status (p>0.25, for all comparisons).

CONCLUSIONS

Our findings show that adiponectin might function as a mechanistic link between omentin SNP and increased risk of cardiometabolic diseases independent of common and central obesity in Asian Indians. Before strategies to promote adiponectin modulation could be implemented, further studies are required to confirm the molecular mechanisms involved in this triangular relationship between omentin gene, adiponectin and cardiometabolic diseases.

Sprint interval training (SIT) reduces serum epidermal growth factor (EGF), but not other inflammatory cytokines in trained older men

Purpose

The present study aimed to investigate the effect of age on circulating pro- and anti-inflammatory cytokines and growth factors. A secondary aim was to investigate whether a novel sprint interval training (SIT) intervention (3 × 20 s ‘all out’ static sprints, twice a week for 8 weeks) would affect inflammatory markers in older men.

Methods

Nine older men [68 (1) years] and eleven younger men [28 (2) years] comprised the younger group. Aerobic fitness and inflammatory markers were taken at baseline for both groups and following the SIT intervention for the older group.

Results

Interleukin (IL)-8, vascular endothelial growth factor (VEGF), and monocyte chemoattractant protein-1 (MCP-1) were unchanged for the older and younger groups at baseline (IL-8, p = 0.819; MCP-1, p = 0.248; VEGF, p = 0.264). Epidermal growth factor (EGF) was greater in the older group compared to the younger group at baseline [142 (20) pg mL⁻¹ and 60 (12) pg mL⁻¹, respectively, p = 0.001, Cohen's d = 1.64]. Following SIT, older men decreased EGF to 100 (12) pg mL⁻¹ which was similar to that of young men who did not undergo training (p = 0.113, Cohen's d = 1.07).

Conclusion

Older aerobically trained men have greater serum EGF than younger aerobically trained men. A novel SIT intervention in older men can shift circulating EGF towards trained younger concentrations. As lower EGF has previously been associated with longevity in C. elegans, the manipulative effect of SIT on EGF in healthy ageing in the human may be of further interest.

Incides of C-Reactive Protein, Tumor Necrosis Factor-α, Adiponectin, Leptin and Resistin in the Blood of Patients Suffering from Chronic Pancreatitis and Type 2 Diabetes Mellitus

Studying the significance of the immune response to damage and adipokine levels is urgent regarding the development of both chronic pancreatitis and type 2 diabetes mellitus. Our objective was to study the indices of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), adiponectin, leptin, and resistin as links for triggering the mechanisms of development and progression of the low-grade chronic systemic inflammatory response in chronic pancreatitis (CP) patients with type 2 diabetes mellitus (T2DM). The study groups consisted of 87 patients: 47 patients with isolated CP (group I), 40 with CP combined with T2DM (group II), and 41 practically healthy persons. It has been established that in patients with isolated CP, the TNF-α concentration showed a reliable 1.57-fold (p <0.05) increase compared to practically healthy persons (PHP) and a 1.32-fold increase in patients who also had T2DM (p<0.05). CP patients with type 2 diabetes mellitus had the highest CRP indices (5.5-fold, p <0.05. TNF-α and C-reactive protein indices were higher in patients with chronic pancreatitis and T2DM than those with isolated chronic pancreatitis, characterizing the persistence of chronic systemic inflammation in case of the combined clinical course of these diseases.

Lifestyle Modification with Physical Activity Promotion on Leptin Resistance and Quality of Life in Metabolic Syndrome - A Systematic Review with Meta-Analysis

OBJECTIVE

This study focused to systematically extract, summarize and analyse the data on the effect of lifestyle modification on leptin resistance and quality of life in metabolic syndrome.

METHODS

The systematic search was done using PubMed, Cochrane Database, EMBASE, Science Direct, CINAHL, Springer link, Web of Science from 2000-2018. English language articles and quantitative studies focusing on leptin resistance and quality of life were included. Random effect analysis was adopted to pool data and estimate 95% CI. The meta-analysis was done separately for leptin resistance and quality of life which included a total of 9 studies on both RCTs and Non-RCTs.

RESULTS

The meta-analysis of RCTs reported insignificant effect of lifestyle modification on leptin resistance in metabolic syndrome when compared to comparison group (-5.94(-14.28, 2.41). Two clinical trials showed a significant effect with pooled data (5.52(2.14, 8.91). Meta-analysis of RCTs focusing on quality of life showed significant effect on mental component (4.89 (0.16, 9.62) of quality of life (2.36 (-3.67, 8.39) when compared to comparison group.

CONCLUSION

This meta-analysis suggested that lifestyle modification has a potential to improve leptin resistance and mental component of quality of life in metabolic syndrome. However, more clearly defined studies are required to come to a stronger conclusion.

Crosstalk Between Dietary Pattern, Anthropometric Parameters, and Adiponectin Concentration Among Patients with Metabolic Syndrome

Background: Adiponectin is known to mediate antidiabetic and cardioprotective metabolic effects. Current evidence suggests that diet, both its quantity and quality, affects adiponectin concentration. Methods: The purpose of this study was to evaluate the association of adiponectin with cardiometabolic risk factors, anthropometric features, and diet characteristics in obese patients with multiple cardiometabolic risk factors. The group of 113 nondiabetic patients (90 males, mean age: 48 ± 9 years) fulfilling the criteria of metabolic syndrome (IDF, 2005) was divided into 2 subgroups according to median adiponectin concentration calculated for that cohort (6.83 μg/mL)-low-adiponectin (LA) and high-adiponectin (HA) subgroup. Biochemical and anthropometric measurements were recorded and nutrients intake was assessed using 24-hr dietary recall method and diet history questionnaire. Results: No significant differences between LA and HA were noted regarding the anthropometric parameters. However, there were significant differences in biochemical indices, and HA was characterized by a more favorable insulin level, homeostasis model assessment of insulin resistance (HOMA-IR) value, and plasma lipid profile than LA. Both LA and HA subgroups were comparable in terms of energy, protein, carbohydrate, and total fat intake, but there were significant differences between the level of polyunsaturated fatty acids (PUFA) consumption (6.06 ± 1.0 and 6.37 ± 1.1, respectively) and omega-3/omega-6 ratio (as follows: 0.09 ± 0.01 and 0.16 ± 0.04). Conclusions: These results highlight interactions between diet, adiponectin concentration, and biochemical profile. Nondiabetic patients with metabolic syndrome with higher PUFA consumption, including higher omega-3/omega-6 ratio, were characterized by higher circulating adiponectin level and more favorable biochemical profile. Thus, it might be assumed that the protective role of omega-3 fatty acids might be mediated by adiponectin in patients with metabolic syndrome.

Elevated GTP Cyclohydrolase I Pathway in Endothelial Progenitor Cells of Overweight Premenopausal Women

Background/Aims. Sexual differences exist in endothelial progenitor cells (EPCs), and various cardiovascular risk factors are associated with the preservation of endothelial function in premenopausal women. However, it is unclear whether differences in endothelial function and circulating EPCs exist between overweight premenopausal women and age-matched men. Methods. We compared EPC counting and functions in normal-weight and overweight premenopausal women and men, evaluated endothelial function in each group, and detected the expression of the guanosine triphosphate cyclohydrolase I (GTPCH I) pathway. Results. The number of EPCs was lower in the male group than in the female group, regardless of normal-weight or overweight status, and there was no significant difference between the different weight groups among females or males. Endothelial function and EPC migration and proliferation were preserved in overweight premenopausal women compared with overweight men as were nitric oxide (NO) levels in plasma and secreted by EPCs. Endothelial function, the circulating EPC population, and NO levels were not different between normal-weight and overweight premenopausal women. Flow-mediated dilatation was significantly correlated with EPC function, plasma NO levels, and EPC-secreted NO. Conclusions. This investigation provides the first evidence for sex-based differences in EPC activity and endothelial function in overweight middle-aged individuals; these differences are associated with alterations in NO production and may partly occur through downregulation of the GTPCH I pathway. The present results provide new insights into the mechanism underlying the preserved endothelial function in overweight premenopausal women and may uncover a potential therapeutic target for endothelial repair in overweight population.

Serum concentration of asprosin in new-onset type 2 diabetes

BACKGROUND

Asprosin, a newly identified adipokine, is pathologically increased in individuals with insulin resistance. However, the available evidence on the association of asprosin and type 2 diabetes mellitus (T2DM) status is still scarce. Therefore, this study aimed to determine the relationship between serum concentrations of asprosin and T2DM status.

METHODS

This observational study was performed based on 194 adults (97 newly diagnosed T2DM and 97 healthy individuals). Anthropometric and biochemical variables were determined in all participants. Serum concentrations of asprosin were measured using enzyme-linked immunosorbent assay (ELISA).

RESULTS

In patients with T2DM, the serum concentrations of asprosin were significantly higher than the healthy controls (4.18 [IQR: 4.4] vs. 3.5 [IQR: 1.85], P < 0.001). The concentrations of asprosin were significantly correlated with body mass index (BMI) and fasting blood glucose (FBG) in healthy subjects and with BMI, FBG, hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and quantitative insulin check index (QUICKI), triacylglycerol (TAG) and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio in the T2DM group. In fully adjusted model, the odds ratio (OR) of T2DM with serum concentrations of asprosin was approximately 1.547 (95% CI 1.293-1.850, P < 0.001) compared to the control group. Multiple stepwise regression analysis indicated that FBG and HOMA-IR were independently associated with asprosin in T2DM.

CONCLUSION

Our findings indicated that serum concentrations of asprosin are increased in patients with T2DM. Also, asprosin is correlated with insulin resistance and TC/HDL-C ratio (atherosclerotic risk factor of cardiovascular diseases) in patients with T2DM.

A Proposed Inflammatory Score of Circulating Cytokines/Adipokines Associated with Resistant Hypertension, but Dependent on Obesity Parameters

Background

There is evidence that subclinical systemic inflammation is present in resistant hypertension (RHTN).

Objective

The aim of the study was to develop an integrated measure of circulating cytokines/adipokines involved in the pathophysiology of RHTN.

Methods

RHTN (n = 112) and mild to moderate hypertensive (HTN) subjects (n=112) were studied in a cross-sectional design. Plasma cytokines/adipokines (TNF-alpha, interleukins [IL]-6, -8, -10, leptin and adiponectin) values were divided into tertiles, to which a score ranging from 1 (lowest tertile) to 3 (highest tertile) was assigned. The inflammatory score (IS) of each subject was the sum of each pro-inflammatory cytokine scores from which anti-inflammatory cytokines (adiponectin and IL-10) scores were subtracted. The level of significance accepted was alpha = 0.05.

Results

IS was higher in RHTN subjects compared with HTN subjects [4 (2-6) vs. 3 (2-5); p = 0.02, respectively]. IS positively correlated with body fat parameters, such as body mass index (r = 0.40; p < 0.001), waist circumference (r = 0.30; p < 0.001) and fat mass assessed by bioelectrical impedance analysis (r = 0.31; p < 0.001) in all hypertensive subjects. Logistic regression analyses revealed that IS was an independent predictor of RHTN (OR = 1.20; p = 0.02), independent of age, gender and race, although it did not remain significant after adjustment for body fat parameters.

Conclusion

A state of subclinical inflammation defined by an IS including TNF-alpha, IL-6, IL-8, IL-10, leptin and adiponectin is associated with obese RHTN. In addition, this score correlates with obesity parameters, independently of hypertensive status. The IS may be used for the evaluation of conditions involving low-grade inflammation, such as obesity-related RHTN. Indeed, it also highlights the strong relationship between obesity and inflammatory process.

Effects of 830 nm low-power laser irradiation on body weight gain and inflammatory cytokines in experimental diabetes in different animal models

Background and aims

The present investigation was carried out to determine the levels of blood serum components and inflammatory cytokines in diabetic rat models [Goto-Kakizaki (GK), Zucker, and streptozotocin (STZ)-induced Sprague Dawley (SD) rats] which underwent abdominal Low-Power Laser Irradiation (LPLI) and compare them with non-irradiated controls.

Methods

The animals were subdivided into the following groups: diabetic control rats (GK, Zucker, STZ) and diabetic rats treated with LPLI (GK + LPLI, Zucker + LPLI, and STZ + LPLI) (n = 7). The animals were irradiated three times weekly for 12 weeks in LPLI (830 nm) at a dose of 5 J/cm² for 500 s.

Results

Body weight was significantly lowered in the Zucker- LPLI group compared to control at 10 weeks and this pattern was maintained until 12 weeks of age. TNF-α, IL-1I and IL-6 levels were significantly decreased (5.1 ± 1.1 vs 3.3 ± 0.5, p < 0.01; 43.6 ± 8.8 vs 27.1 ± 3.8, p < 0.01; 98.3 ± 15.8 vs 62.2 ± 12.1, p < 0.01) in the Zucker- LPLI group compared with the control rats. The small intestinal transit rates of charcoal meals were significantly decreased (58.1 ± 10.1 vs 73.4 ± 13.3, p < 0.05) in the Zucker-LPLI group compared with the control rats. Similarly, the serum levels of glucose, cholesterol and triglycerides of LPLI groups were decreased in comparison with that of diabetic control rats.

Conclusions

We suggest that abdominal LPLI can reduce body weight and LPLI could be applicable for use against diabetic-induced inflammatory factors.

Adipose tissue-derived cytokines and their correlations with clinical characteristics in Vietnamese patients with type 2 diabetes mellitus

BACKGROUND

Adipokines are involved in the pathogenesis of metabolic disorders including obesity and type 2 diabetes mellitus (T2DM). This study investigates the levels of leptin, resistin, visfatin, secreted frizzled-related protein 5 (SFRP5), monocyte chemoattractant protein-1 (MCP-1) and retinol-binding protein 4 (RBP4) and their correlations with clinical parameters of overweight and T2DM.

METHODS

We recruited overweight 50 patients with T2DM, 88 non-overweight patients with T2DM, 29 overweight and 100 non-overweight individuals devoid of T2DM for this study. The levels of studied adipokines were measured by enzyme-linked immunosorbent assay and correlated with clinical parameters.

RESULTS

The levels of MCP-1 and SFRP5 were decreased while visfatin and RBP4 levels were increased in patients with T2DM compared to those in the control individuals (P < 0.01). Among patients with T2DM, leptin and resistin levels were higher while RBP4 levels were lower in patients with overweight T2DM compared to those in patients with non-overweight T2DM (P < 0.0001, 0.019 and 0.05, respectively). Leptin and MCP-1 levels were correlated with HOMA-IR, QUICKI and HOMA-β. Leptin/MCP-1 ratio was correlated with insulin levels, HOMA-IR and HOMA-β indexes. Resistin/RBP4, visfatin/MCP-1 and MCP-1/RBP4 ratios were strongly correlated with the levels of fasting glucose, HbA1c and HOMA-β. In addition, ROC curve analyses indicated a diagnostic potential of resistin/RBP4 and MCP-1/RBP4 indexes for T2DM (AUC = 0.81 and 0.83, respectively) and β-cell function (AUC = 0.76 and 0.74, respectively).

CONCLUSIONS

Adipokines (leptin, resistin, visfatin, SFRP5, MCP-1, and RBP4) are associated with overweight and T2DM and may serve as a potential prognostic marker and therapeutic intervention for overweight-related T2DM.

Cytokine Responses to Acute Exercise in Healthy Older Adults: The Effect of Cardiorespiratory Fitness

Markers of chronic inflammation increase with aging, and are associated with cardiovascular disease prevalence and mortality. Increases in fitness with exercise training have been associated with lower circulating concentrations of cytokines known to have pro-inflammatory actions (such as interleukin-6 [IL-6]) and higher circulating concentrations of anti-inflammatory cytokines (interleukin-10 [IL-10]). However, the effect of cardiorespiratory fitness on acute cytokine responses to a single bout of exercise in healthy older individuals is unknown. We compared the response of plasma cytokines IL-6, tumor necrosis factor-alpha (TNF-α) and IL-10 to a bout of moderate-intensity continuous and higher-intensity interval exercise between older individuals with higher and lower levels of cardiorespiratory fitness. Sixteen lower-fit (VO_2peak: 22.6±2.8 mL.kg⁻¹.min⁻¹) and fourteen higher-fit participants (VO_2peak: 37.4±5.9 mL.kg⁻¹.min⁻¹) completed three 24 min experimental protocols in a randomized order: (1) moderate-intensity continuous exercise (40% of peak power output [PPO]); (2) higher-intensity interval exercise (12 × 1 min intervals at 70% PPO separated by 1 min periods at 10% PPO); or (3) non-exercise control. Plasma cytokines were measured at rest, immediately after, and during 90 min of recovery following exercise or control. Plasma IL-6 concentrations at baseline were greater in the higher-fit compared to the lower-fit group (P = 0.02), with no difference in plasma IL-10 or TNF-α concentrations at baseline between groups. Plasma IL-6 and IL-10 concentrations in both groups increased immediately after all protocols (IL-6: P = 0.02, IL-10: P < 0.01). However, there was no difference in the IL-6 and IL-10 response between the exercise and non-exercise (control) protocols. After all protocols, no changes in plasma TNF-α concentrations were observed in either the higher- or lower-fit groups. In this study, basal concentrations of circulating IL-6 were elevated in older individuals with higher levels of cardiorespiratory fitness. However, changes in plasma cytokine concentrations after exercise were not different to changes after non-exercise control in both the lower- and higher-fit groups.

Type 2 diabetes mellitus risk and exercise: is resistin involved?

Obesity and associated disorders such as type 2 diabetes mellitus (T2DM) pose an increasing risk to the health of both individuals and society. Adipose tissue is an active endocrine organ, secreting many hormones, known as adipokines. Evidence suggests that one suggest adipokine, resistin, may be elevated in the plasma of individuals with T2DM, and early reports indicated that this may contribute to the impaired glucose tolerance and insulin resistance observed in T2DM, hence its name, resistin, however subsequent evidence suggests it may have a proinflammatory role. Performing regular exercise and dietary interventions improve insulin sensitivity and glucose tolerance in the majority of individuals with T2DM, and we hypothesized that plasma resistin levels may drop in individuals following a long term aerobic and/or resistance exercise intervention program. Articles analyzing the effects of exercise on serum resistin levels were therefore analyzed. Articles were selected and analyzed based on a minimum aerobic and/or resistance training program of 2 sessions per week for 12 weeks. Plasma resistin levels decreased following either endurance aerobic exercise and/or resistance training plans in individuals with obesity and/or insulin resistance, although this was not related to BMI change. Exercise intervention programs generally showed potentially beneficial changes in plasma resistin concentrations. It is possible these effects are mediated through exercise-induced decreases in inflammation via anti-inflammatory cytokine release rather than alterations in glucose metabolism and reductions in BMI per se. A possible link between resistin, exercise and T2DM is discussed.

Structural difference of palm based Medium- and Long-Chain Triacylglycerol (MLCT) further reduces body fat accumulation in DIO C57BL/6J mice when consumed in low fat diet for a mid-term period

Medium-and-Long Chain Triacylglycerol (MLCT) is a type of structured lipid that is made up of medium chain, MCFA (C8-C12) and long chain, LCFA (C16-C22) fatty acid. Studies claimed that consumption of MLCT has the potential in reducing visceral fat accumulation as compared to long chain triacylglycerol, LCT. This is mainly attributed to the rapid metabolism of MCFA as compared to LCFA. Our study was designed to compare the anti-obesity effects of a enzymatically interesterified MLCT (E-MLCT) with physical blend of palm kernel and palm oil (B-PKOPO) having similar fatty acid composition and a commercial MLCT (C-MLCT) made of rapeseed/soybean oil on Diet Induced Obesity (DIO) C57BL/6J mice for a period of four months in low fat, LF (7%) and high fat, HF (30%) diet. The main aim was to determine if the anti-obesity effect of MLCT was contributed solely by its triacylglycerol structure alone or its fatty acid composition or both. Out of the three types of MLCT, mice fed with Low Fat, LF (7%) E-MLCT had significantly (P<0.05) lower body weight gain (by ~30%), body fat accumulation (by ~37%) and hormone leptin level as compared to both the LF B-PKOPO and LF C-MLCT. Histological examination further revealed that dietary intake of E-MLCT inhibited hepatic lipid accumulation. Besides, analysis of serum profile also demonstrated that consumption of E-MLCT was better in regulating blood glucose compared to B-PKOPO and C-MLCT. Nevertheless, both B-PKO-PO and E-MLCT which contained higher level of myristic acid was found to be hypercholesterolemic compared to C-MLCT. In summary, our finding showed that triacylglycerol structure, fatty acid composition and fat dosage play a pivotal role in regulating visceral fat accumulation. Consumption of E-MLCT in low fat diet led to a significantly lesser body fat accumulation. It was postulated that the MLM/MLL/LMM/MML/LLM types of triacylglycerol and C8-C12 medium chain fatty acids were the main factors that contributed to the visceral fat suppressing effect of MLCT. Despite being able to reduce body fat, the so called healthful functional oil E-MLCT when taken in high amount do resulted in fat accumulation. In summary, E-MLCT when taken in moderation can be used to manage obesity issue. However, consumption of E-MLCT may lead to higher total cholesterol and LDL level.

Concurrent Aerobic and Resistance Training Has Anti-Inflammatory Effects and Increases Both Plasma and Leukocyte Levels of IGF-1 in Late Middle-Aged Type 2 Diabetic Patients

Type 2 diabetes (T2D) is an age-related chronic disease associated with metabolic dysregulation, chronic inflammation, and activation of peripheral blood mononuclear cells (PBMC). The aim of this study was to assess the effects of a concurrent exercise training program on inflammatory status and metabolic parameters of T2D patients. Sixteen male patients (age range 55–70) were randomly assigned to an intervention group (n = 8), which underwent a concurrent aerobic and resistance training program (3 times a week; 16 weeks), or to a control group, which followed physicians' usual diabetes care advices. Training intervention significantly improved patients' body composition, blood pressure, total cholesterol, and overall fitness level. After training, plasma levels of adipokines leptin (−33.9%) and RBP4 (−21.3%), and proinflammatory markers IL-6 (−25.3%), TNF-α (−19.8%) and MCP-1 (−15.3%) decreased, whereas anabolic hormone IGF-1 level increased (+16.4%). All improvements were significantly greater than those of control patients. Plasma proteomic profile of exercised patients showed a reduction of immunoglobulin K light chain and fibrinogen as well. Training also induced a modulation of IL-6, IGF-1, and IGFBP-3 mRNAs in the PBMCs. These findings confirm that concurrent aerobic and resistance training improves T2D-related metabolic abnormalities and has the potential to reduce the deleterious health effects of diabetes-related inflammation.

Adiponectin and pro-inflammatory cytokines are modulated in Vietnamese patients with type 2 diabetes mellitus

AIMS/INTRODUCTION

Adipose tissue-derived hormones are associated with metabolic disorders including type 2 diabetes mellitus. The present study investigated the levels of adiponectin and pro-inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-1 beta (IL-1β) and IL-10 in Vietnamese patients with type 2 diabetes mellitus, and their correlations with clinical parameters of overweight and type 2 diabetes mellitus.

MATERIALS AND METHODS

Based on body mass index, 73 patients with type 2 diabetes mellitus were categorized either as overweight or non-overweight. As healthy controls, 57 overweight and non-overweight individuals without type 2 diabetes mellitus were included. The adiponectin, TNF-α, IL-1β and IL-10 levels were measured in the sera samples in all study participants by enzyme-linked immunosorbent assay and were correlated with clinical parameters.

RESULTS

The adiponectin levels were lower in patients with type 2 diabetes mellitus (2.5 ± 1.5 μg/mL) compared with controls (16 ± 18.6 μg/mL; P < 0.0001), and were decreased in overweight individuals compared with those who were not overweight. The TNF-α and IL-1β levels were increased, whereas the IL-10 levels were decreased in patients with type 2 diabetes mellitus and in overweight controls compared with non-overweight controls (P < 0.0001). The adiponectin levels were correlated with the TNF-α, IL-1β, IL-10 levels, and the clinical parameters of overweight and type 2 diabetes mellitus. The quantitative insulin sensitivity check index and homeostasis model assessment insulin resistance indexes were correlated with the relative ratios of adiponectin/TNF-α, adiponectin/IL-1β, adiponectin/IL-10, TNF-α/IL-10 and IL-1β/IL-10.

CONCLUSIONS

Adiponectin and pro-inflammatory cytokines are associated with type 2 diabetes mellitus, and might serve as a prognostic marker and a therapeutic intervention for overweight-related type 2 diabetes mellitus.

Treatment of Obesity: Weight Loss and Bariatric Surgery

This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health, which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by nonsurgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the comorbidities, quality of life, and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes mellitus, inflammation, obstructive sleep apnea, and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors after weight loss, it is reasonable to expect a reduction of CVD events and related mortality after weight loss in populations with obesity. The quality of the current evidence is reviewed, and future research opportunities and summaries are stated.

Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: a 5-year longitudinal study

OBJECTIVE

We evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular risk factors in real-world clinical practice.

METHODS

We evaluated 129 obese patients with diabetes enrolled in Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week clinical model of intensive lifestyle intervention. After 1 year, we divided participants into group A, who maintained <7% weight loss (47.3%) and group B (52.7%), who maintained ≥7% weight loss. We continued to follow them for a total of 5 years.

RESULTS

The total cohort lost 23.8 lbs (-9.7%) at 12 weeks and maintained -16.2 lbs (-6.4%) at 5 years (p<0.001). Group A maintained -8.4 lbs (-3.5%) and group B maintained -23.1 lbs (-9.0%) at 5 years. In group A, A1C decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but increased to 7.7±1.4% at 1 year and 8.0±1.9% at 5 years. In group B, A1C decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks and rose to 6.8±1.2% at 1 year and 7.3±1.5% at 5 years. Despite weight regain, group A maintained improvement in low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol with worsening of serum triglycerides and no change in blood pressure (BP). Group B maintained improvement in lipid profile for 5 years and had significantly lower BP for 18 months.

CONCLUSIONS

Weight reduction in patients with diabetes can be maintained for 5 years and is predicted by patients' ability to maintain ≥7% weight loss at 1 year. A1C and triglycerides deteriorate with weight regain, while other lipid improvements are maintained. Sustained weight loss is associated with significantly lower A1C for 5 years and lowers BP for 18 months.

TRIAL REGISTRATION NUMBER

NCT01937845.

Endothelial dysfunction biomarker, endothelial cell-specific molecule-1, and pediatric metabolic syndrome

BACKGROUND

The aim of this study was to compare serum endothelial cell-specific molecule-1 (endocan) in pediatric patients with metabolic syndrome (MetS) and in healthy children, and to determine whether it can be used as an indicator of endothelium damage-induced complications in pediatric MetS patients.

METHODS

The study included 30 patients, aged 6-16 years, who were diagnosed with MetS. Another 30 children with no diseases were recruited as healthy controls. Endocan concentration was measured using enzyme-linked immunosorbent assay.

RESULTS

Endocan was increased almost threefold in the MetS group compared with the healthy group. Systolic arterial tension and diastolic arterial tension, serum triglyceride, total cholesterol, and low-density lipoprotein cholesterol were higher, and high-density lipoprotein cholesterol was lower, in the MetS children than in the healthy group. Fasting blood glucose (FBG), hemoglobin A1c (HBA1C), and homeostasis model assessment insulin resistance (HOMA-IR) were also significantly increased in the children with MetS compared with the healthy group.

CONCLUSIONS

Serum endocan level in pediatric MetS patients could be an important indicator of cardiovascular risk in adulthood.

Gene Expression Patterns Are Altered in Athymic Mice and Metabolic Syndrome Factors Are Reduced in C57BL/6J Mice Fed High-Fat Diets Supplemented with Soy Isoflavones

Soy isoflavones exert beneficial health effects; however, their potential to ameliorate conditions associated with the metabolic syndrome (MetS) has not been studied in detail. In vitro and in vivo models were used to determine the effect of isoflavones on lipid metabolism, inflammation, and oxidative stress. In nude mice, consumption of Novasoy (NS) increased cholesterol and lipid metabolism gene expression, including Scd-1 (27.7-fold), Cyp4a14 (35.2-fold), and Cyp4a10 (9.5-fold), and reduced anti-inflammatory genes, including Cebpd (16.4-fold). A high-fat (HF) diet containing 0.4% (w/w) NS for 10 weeks significantly reduced percent weight gain (74.6 ± 2.5 vs 68.6 ± 3.5%) and hepatic lipid accumulation (20 ± 1.2 vs 27 ± 1.5%), compared to HF alone (p < 0.05) in C57BL/6J mice. NS also increased lipid oxidation and antioxidant gene expression while decreasing inflammatory cytokines. In vitro analysis in HepG2 cells revealed that genistein dose-dependently decreases oleic acid-induced lipid accumulation. Soy isoflavones may ameliorate symptoms associated with MetS via anti-inflammatory, antioxidant, and hypolipidemic modulation.

Effect of DHA supplementation in a very low-calorie ketogenic diet in the treatment of obesity: a randomized clinical trial

A VLCK diet supplemented with DHA, commercially available, was tested against an isocaloric VLCK diet without DHA. The main purpose of this study was to compare the effect of DHA supplementation in classic cardiovascular risk factors, adipokine levels, and inflammation-resolving eicosanoids. A total of obese patients were randomized into two groups: a group supplemented with DHA (n = 14) (PnK-DHA group) versus a group with an isocaloric diet free of supplementation (n = 15) (control group). The follow-up period was 6 months. The average weight loss after 6 months of treatment was 20.36 ± 5.02 kg in control group and 19.74 ± 5.10 kg in PnK-DHA group, without statistical differences between both groups. The VLCK diets induced a significant change in some of the biological parameters, such as insulin, HOMA-IR, triglycerides, LDL cholesterol, C-reactive protein, resistin, TNF alpha, and leptin. Following DHA supplementation, the DHA-derived oxylipins were significantly increased in the intervention group. The ratio of proresolution/proinflammatory lipid markers was increased in plasma of the intervention group over the entire study. Similarly, the mean ratios of AA/EPA and AA/DHA in erythrocyte membranes were dramatically reduced in the PnK-DHA group and the anti-inflammatory fatty acid index (AIFAI) was consistently increased after the DHA treatment (p < 0.05). The present study demonstrated that a very low-calorie ketogenic diet supplemented with DHA was significantly superior in the anti-inflammatory effect, without statistical differences in weight loss and metabolic improvement.

Review: Non-alcoholic fatty liver disease: natural history, pathogenesis and treatment

Non-alcoholic fatty liver disease (NAFLD) is the term used to describe the alcohol-like liver injury that occurs in the absence of alcohol abuse. It embraces a range of histological abnormalities including simple steatosis or fatty liver, non-alcoholic steatohepatitis (NASH) and NAFLD induced cirrhosis. The predominant risk factor for NAFLD appears to be insulin resistance. Simple steatosis and NASH are generally asymptomatic and it is only the development of cirrhosis that has clinical consequence. At present, therapy in NAFLD concentrates on managing risk factors but in the future clinical trials may provide robust evidence for the use of insulin sensitising agents and other potential therapies.

What is the impact of n-3 PUFAs on inflammation markers in Type 2 diabetic mellitus populations?: a systematic review and meta-analysis of randomized controlled trials

Objectives

To explore the possible role of n-3 polyunsaturated fatty acids (PUFAs) in lowering inflammation markers in individuals with type 2 diabetes mellitus.

Methods

PubMed, CNKI and Cochrane databases were searched until December 30, 2015; references from papers or reviews were also retrieved and screened. Screening was performed by two independent researchers, and randomized controlled trials reporting the specific n-3 PUFA type, dose, frequency, and duration of treatment, as well as the baseline and follow-up concentrations of inflammation markers, including interleukin 2 (IL-2), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP), were selected for final analysis. Data analysis was performed using RevMan 5.2 software.

Results

Eight studies involving 955 participants were included; all reported CRP. Only one included study reported IL-2 or IL-6 while two studies reported TNF-α. N-3 PUFAs significantly reduced CRP concentration compared with control [SMD 95 % CI, 1.90 (0.64, 3.16), Z = 2.96, P = 0.003, random effect model].

Conclusions

N-3 PUFAs decrease CRP concentration in type-2 diabetes mellitus. However, larger and rigorously designed RCTs are required to confirm this finding and extend it into other inflammatory biomarkers.

Electronic supplementary material

The online version of this article (doi:10.1186/s12944-016-0303-7) contains supplementary material, which is available to authorized users.

Resistin's, obesity and insulin resistance: the continuing disconnect between rodents and humans

PURPOSE

This review aimed to discuss the conflicting findings from resistin research in rodents and humans as well as recent advances in our understanding of resistin's role in obesity and insulin resistance.

METHODS

A comprehensive review and synthesis of resistin's role in obesity and insulin resistance as well as conflicting findings from resistin research in rodents and humans.

RESULTS

In rodents, resistin is increased in high-fat/high-carbohydrate-fed, obese states characterized by impaired glucose uptake and insulin sensitivity. Resistin plays a causative role in the development of insulin resistance in rodents via 5' AMP-activated protein kinase (AMPK)-dependent and AMPK-independent suppressor of cytokine signaling-3 (SOCS-3) signaling. In contrast to rodents, human resistin is primarily secreted by peripheral-blood mononuclear cells (PBMCs) as opposed to white adipocytes. Circulating resistin levels have been positively associated with central/visceral obesity (but not BMI) as well as insulin resistance, while other studies show no such association. Human resistin has a role in pro-inflammatory processes that have been conclusively associated with obesity and insulin resistance. PBMCs, as well as vascular cells, have been identified as the primary targets of resistin's pro-inflammatory activity via nuclear factor-κB (NF-κB, p50/p65) and other signaling pathways.

CONCLUSION

Mounting evidence reveals a continuing disconnect between resistin's role in rodents and humans due to significant differences between these two species with respect to resistin's gene and protein structure, differential gene regulation, tissue-specific distribution, and insulin resistance induction as well as a paucity of evidence regarding the resistin receptor and downstream signaling mechanisms of action.

Leptin, Leptin Soluble Receptor, and the Free Leptin Index following a Diet and Physical Activity Lifestyle Intervention in Obese Males and Females

Leptin (LEP) is associated with appetite regulation and metabolism. Concentration is linear with adiposity, suggesting LEP resistance. LEP circulates freely and bound with its soluble receptor (sOB-r); the ratio is the free leptin index (FLI), an index of leptin resistance; lower FLI suggests reduced biological action. Purpose. The aim was to determine the effect of changes in adipose tissue distribution on LEP, sOB-r, and FLI following 6 months (6 M) of a diet/exercise weight loss program (WLP). In addition, we aim to identify predictors of the FLI. Methods. 6 M WLP consisted of diet/lifestyle interventions following ADA guidelines. Body composition was assessed by DXA. LEP and sOB-r analysis were done via ELISA. Results. 10 adults completed the WLP. Significant reductions were seen in total fat percentage (% fat), nontrunk fat, (NTF), and trunk fat (TF) from base to 3 m and 6 M (p ≤ 0.05). The FLI were reduced at 3 M and 6 M for males and 6 M for females. Total body fat and body weight predicted the FLI in both sexes. Conclusions. LEP and FLI reductions following 6 M of WLP were achieved independent of sOB-r changes. We also demonstrate that the FLI can be predicted noninvasively through total fat mass and body weight in kilograms.

High-Fat Diets Containing Different Amounts of n3 and n6 Polyunsaturated Fatty Acids Modulate Inflammatory Cytokine Production in Mice

Dysregulation of adipokines is a hallmark of obesity. Polyunsaturated fatty acids in fish oil may exert anti-inflammatory effects on adipose tissue mitigating the dysregulation of adipokines thereby preventing obesity. This study investigated the effects of high-fat diets containing different amounts of n3 polyunsaturated fatty acids (PUFA) on adiposity and adipokine production in mice. Mice were fed a low-fat or a high-fat diet with 16 or 45 % of energy from corn oil (low n3 PUFA) in comparison with a high-fat diet containing soybean or high-oleic sunflower oil (adequate n3 PUFA) or flaxseed or fish oil (high n3 PUFA) for 11 weeks. High-fat diets, regardless of types of oils, significantly increased body fat mass and body weights compared to the low-fat diet. Adipose fatty acid composition and contents reflected dietary fatty acid profiles. The high-fat fish oil diet significantly increased adiponectin and reduced leptin concentrations in both plasma and adipose tissue; it did not elevate plasma insulin concentration compared to the high-fat corn oil diet. All high-fat diets elevated concentrations of plasminogen activator inhibitor-1 (PAI-1) and monocyte chemoattractant protein-1 (MCP-1) but lowered resistin concentrations in both plasma and adipose tissue. In conclusion, fish oil may be beneficial in improving insulin sensitivity by upregulation of adiponectin and downregulation of leptin production; n3 and n6 PUFA do not play a role at the dietary levels tested in reducing adiposity and production of pro-inflammatory cytokines (leptin, PAI-1, MCP-1 and resistin) and anti-inflammatory cytokine adiponectin.

Impact of Nutrition on Cerebral Circulation and Cognition in the Metabolic Syndrome

The increasing prevalence of Metabolic Syndrome (MetS), defined as the clustering of abdominal obesity, dyslipidemia, hypertension, and hyperglycemia, appears to be driving the global epidemics cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Nutrition has a major impact on MetS and plays an important role in the prevention, development, and treatment of its features. Structural and functional alterations in the vasculature, associated with MetS, might form the link between MetS and the increased risk of developing CVD and T2DM. Not only does the peripheral vasculature seem to be affected, but the syndrome has a profound impact on the cerebral circulation and thence brain structure as well. Furthermore, strong associations are shown with stroke, cognitive impairment, and dementia. In this review the impact of nutrition on the individual components of MetS, the effects of MetS on peripheral and cerebral vasculature, and its consequences for brain structure and function will be discussed.

Antidiabetogenic effects of hydroxychloroquine on insulin sensitivity and beta cell function: a randomised trial

AIMS/HYPOTHESIS

Hydroxychloroquine (HCQ), an antimalarial drug with anti-inflammatory properties, is employed in rheumatic diseases. In observational studies, patients with rheumatic diseases treated with HCQ have a lower risk of developing diabetes. However, the physiological mechanisms remain unexplained. We hypothesised that HCQ may have favourable effects on insulin sensitivity and/or beta cell function.

METHODS

This was a randomised, double-blind, parallel-arm (placebo vs HCQ 400 mg/day) trial at the University of Pittsburgh. Randomisation was conducted by a computer system with concealment by sealed envelopes. Treatment duration was 13 ± 1 weeks. Randomised participants (HCQ n = 17; placebo n = 15) were non-diabetic volunteers, age >18, overweight or obese, with one or more markers of insulin resistance. All participants were included in intention-to-treat analysis. Outcomes were changes in insulin sensitivity and beta cell function measured by intravenous glucose tolerance tests and minimal model analysis.

RESULTS

There was a positive change in insulin sensitivity with HCQ but not placebo (mean ± SEM: +20.0% ± 7.1% vs -18.4% ± 7.9%, respectively; p < 0.01; difference: 38.3% ± 10.6%; 95% CI: 17%, 60%). Improvement in beta cell function was also observed with HCQ but not placebo (+45.4% ± 12.3% vs -19.7% ± 13.6%; p < 0.01; difference: 65% ± 19%; 95% CI: 27%, 103%). There were modest treatment effects on fasting plasma glucose and HbA(1c) (p < 0.05) but circulating markers of inflammation (IL-6, IL-1, TNF-α, soluble intercellular adhesion molecule) were not affected in either group. In contrast, adiponectin levels increased after HCQ treatment but not after placebo (+18.7% vs +0.7%, respectively; p < 0.001). Both low- and high-molecular-weight adiponectin forms accounted for the increase. There were no serious or unexpected adverse effects.

CONCLUSIONS/INTERPRETATION

HCQ improves both beta cell function and insulin sensitivity in non-diabetic individuals. These metabolic effects may explain why HCQ treatment is associated with a lower risk of type 2 diabetes. An additional novel observation is that HCQ improves adiponectin levels, possibly being a mediator of the favourable effects on glucose metabolism. Our findings suggest that HCQ is a drug with considerable metabolic effects that warrant further exploration in disorders of glucose metabolism.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01326533 FUNDING: This study was funded by National Institutes of Health no. 5R21DK082878, UL1-RR024153 and UL-1TR000005.

Effects of a high-protein/low carbohydrate versus a standard hypocaloric diet on adipocytokine levels and insulin resistance in obese patients along 9 months

OBJECTIVE

Recent dietary trials and observational studies have focused on the effects of diet on health outcomes such as improvement in levels of surrogate biomarkers. The aim of our study was to examine the changes in weight, adipocytokines levels and insulin resistance after a high-protein/low carbohydrate hypocaloric diet vs. a standard hypocaloric diet during an intervention of 9 months.

SUBJECTS AND METHODS

331 obese subjects were randomly allocated to one of two diets for a period of 9 months. Diet HP (n=168) (high-protein hypocaloric diet) consisted in a diet of 1050 cal/day, 33% of carbohydrates, 33% of fats and 34% of proteins. Diet S (n=163) (standard protein hypocaloric diet) consisted in a diet of 1093 cal/day, 53% carbohydrates, 27%fats, and 20% proteins.

RESULTS

With the diets HP and S, BMI, weight, fat mass, waist circumference, waist-to-hip ratio, systolic blood pressure, total cholesterol, LDL-cholesterol, insulin and HOMA decreased. The decrease at 9 months of (BMI: -2.6±1.3kg/m(2) vs. -2.1±1.2kg/m(2):p<0.05), weight (-8.4±4.2kg vs. -5.0±4.1kg: p<0.05), fat mass (-5.1±4.1kg vs. -3.4±4.2kg: p<0.05), systolic blood pressure (-5.1±7.1mmHg vs. -3.1±2.1mmHg: p<0.05), (insulin levels -4.0±4.8 UI/L vs. -2.2±2.4 UI/L; p<0.05) and HOMA (-0.8±1.0 units vs. -0.3±1.0 units; p<0.05) was higher in diet HP than Diet S. With both diets, leptin levels decreased.

CONCLUSION

A high-protein/low carbohydrate hypocaloric diet shows a higher weight loss, insulin and HOMA-R decreased after 9 months than a standard hypocaloric diet. The improvement in adipokine levels was similar with both diets.

Ethanol Extract of Persimmon Tree Leaves Improves Blood Circulation and Lipid Metabolism in Rats Fed a High-Fat Diet

The leaves of the persimmon tree (PL) are known to have beneficial effects on hyperglycemia, dyslipidemia, and nonalcoholic fatty liver disease. We recently demonstrated that PL had antithrombotic properties in vitro. However, little is known about the antiplatelet and anticoagulant properties of PL in vivo. Omega-3 fatty acid (n-3 FA)-containing fish oil has been widely prescribed to improve blood circulation. This study compared the effects of dietary supplementation with an ethanol extract of PL or n-3 FA on blood coagulation, platelet activation, and lipid levels in vivo. Sprague-Dawley rats were fed a high-fat diet with either PL ethanol extract (0.5% w/w) or n-3 FA (2.5% w/w) for 9 weeks. Coagulation was examined by monitoring the activated partial thromboplastin time (aPTT) and prothrombin time. We examined plasma thromboxane B2 (TXB2), serotonin, and soluble P-selectin (sP-selectin) levels. The aPTT was significantly prolonged in the PL and n-3 FA supplement groups. PL also attenuated the TXB2 level and lowered arterial serotonin transporter mRNA expression, although it did not alter plasma serotonin or sP-selectin levels. C-reactive protein and leptin levels were significantly reduced by PL and n-3 FA supplementation. In addition, PL decreased plasma total- and low-density lipoprotein-cholesterol levels, as did n-3 FA treatment. These results indicated that the PL ethanol extract may have the potential to improve circulation by inhibiting blood coagulation and platelet activation and by reducing plasma cholesterol levels.

Effects of 8-week combined training on body composition, isokinetic strength, and cardiovascular disease risk factors in older women

BACKGROUND AND AIMS

Decline in muscle endurance and strength as well as attenuated cardiac function with aging not only leads to overall physical function decline but also has a close relationship with cardiovascular disease occurrence. This study examined the effects of an 8-week combined training program (i.e., consisting of both aerobic and resistance training) on body composition, isokinetic strength, and cardiovascular disease (CVD) risk factors in older women.

METHODS

Nineteen women, aged 65-75 years, were randomly assigned to either a combined training (CT, n = 9) or an aerobic training (AT, n = 10) group. Body composition and isokinetic strength were assessed before and after the exercise program. Blood samples were collected to identify CVD risk factors.

RESULTS

At the end of the training program, body mass, body fat mass, percent body fat, and body mass index decreased significantly and lean mass increased significantly in the CT group compared with those in the AT group (p < 0.05). Isokinetic strength was also significantly greater in the CT group than in the AT group (p < 0.05). In addition, the C-reactive protein level was significantly lower in the CT group than in the AT group, whereas interleukin-6, tumor necrosis factor-α, and total cholesterol levels were significantly lower in both groups (p < 0.05).

CONCLUSIONS

An 8-week combined exercise program benefits body composition, especially lean mass, and positively affects isokinetic strength and CVD risk factors. Therefore, increasing lean mass and strength by continuously participating in a combined exercise program may be an effective treatment for preventing and improving CVD in older women.

Physical activity in overweight and obese adolescents: systematic review of the effects on physical fitness components and cardiovascular risk factors

BACKGROUND

The increasing prevalence of obesity in the pediatric age range has become a major concern. Studies have investigated the role of physical activity (PA) to prevent obesity in this population. However, previous reviews did not focus on the effects of PA in overweight/obese adolescents on physical fitness and risk factors for cardiovascular disease altogether.

OBJECTIVE

The present systematic review analyzed trials investigating the effect of PA on aerobic capacity, muscle strength, body composition, hemodynamic variables, biochemical markers, and endothelial function in obese/overweight adolescents.

METHODS

PubMed, LILACS, Web of Science, Scopus (including Embase), and SPORTDiscus databases were searched for relevant reports without time limits. Inclusion criteria included studies published in English, with overweight and obese adolescents aged 12-17 years. The review was registered (Number CRD42013004632) on PROSPERO, the International Prospective Register of Systematic Reviews.

RESULTS

The results indicated that PA is associated with significant and beneficial changes in fat percentage, waist circumference, systolic blood pressure, insulin, low-density lipoprotein cholesterol, and total cholesterol, as well as with small non-significant changes in diastolic blood pressure, glucose, and high-density lipoprotein cholesterol.

CONCLUSION

Although limited, results from controlled trials suggest that PA intervention may improve physical fitness and risk factors for cardiovascular disease in adolescents who are overweight or obese.

Is there a role for leptin in the reduction of depression symptoms during weight loss therapy in obese adolescent girls and boys?

Several studies have sought to clarify the association between adolescent obesity and psychological distress. Recently, a biological link between leptin resistance and depression has been proposed. The aim of the present study was to examine changes in leptin concentrations as a potential predictor of reduced depression symptoms in obese adolescents during long-term interdisciplinary weight loss therapy. Seventy-five obese adolescents (age: 16.28±2.37 years; BMI: 35.65±4.64 kg/m2) engaged in a long-term interdisciplinary therapy for weight loss. They were evaluated at baseline and after 1 year of treatment for body composition, serum analyses and depression symptomatology. After therapy, body mass BMI, fat mass (% and kg), waist circumference, visceral, subcutaneous and visceral/subcutaneous fat and depression symptoms decreased and lean mass (%) increased significantly. There was an improvement in inflammatory profiles with a significant reduction in leptin and increase in adiponectin. Regression analyses showed that decreased leptin predicted amelioration in depression symptoms independent of age, gender and changes in visceral fat, body mass, fat mass (%) and leptin/adiponectin ratio. These associations appear stronger in girls than boys. The attenuation of hyperleptinemia appears to play an important role in the association between weight loss and depression, particularly in obese girls.

Myeloperoxidase is associated with insulin resistance and inflammation in overweight subjects with first-degree relatives with type 2 diabetes mellitus

BACKGROUND

Family history of type 2 diabetes mellitus (T2DM) is one of risk factors for that in future a subject can develop diabetes. Insulin resistance (IR) is important in the pathogenesis of T2DM. There is evidence that oxidative stress plays an important role in the etiology and/or progression of diabetes. Myeloperoxidase (MPO) participates in developing of inflammation. The objective was to investigate if MPO is associated with IR and inflammation in individuals with first-degree relatives of T2DM.

METHODS

Cross-sectional study in 84 overweight individuals with family history of T2DM divided in two groups according to IR, group with IR (homeostasis model assessment [HOMA] ≥2.5; n=43) and control group (CG; HOMA <2.5; n=41). Complete clinical history and a venous blood sample were collected for measuring glucose and lipids profile, insulin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), MPO, glutathione reductase (GRd), glutathione peroxidase, and superoxide dismutase.

RESULTS

MPO, TNF-α, and IL-6 were higher in patients with IR than in CG (MPO: 308.35 [190.85 to 445.42] vs. 177.35 [104.50 to 279.85], P=0.0001; TNF-α: 13.46 [10.58 to 18.88] vs. 9.39 [7.53 to 11.25], P=0.0001; IL-6: 32.93 [24.93 to 38.27] vs. 15.60 [12.93 to 26.27]; P=0.0001, respectively). MPO was associated with IR (rho de Spearman=0.362, P=0.001). In the analysis of lineal regression, MPO predicts IR (β, 0.263; t, 2.520; P=0.014). In the univariate analysis, MPO had an odds ratio of 9.880 for risk of IR (95% confidence interval, 2.647 to 36.879).

CONCLUSION

MPO had relation with IR and inflammation parameters in overweight subjects with first-degree relatives of T2DM. We need studies on a casual relationship and molecular mechanisms among the increased serum MPO levels, inflammation markers, and IR.