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Adelmeyer J, Schauer CM, Kann PH. Spontaneous hypoglycemia: should we mind the gap? Long-term follow-up of healthy people who met Whipple's triad criteria. Hormones (Athens) 2024; 23:447-455. [PMID: 38457064 PMCID: PMC11436464 DOI: 10.1007/s42000-024-00542-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
CONTEXT Patients discharged as "healthy" with the symptoms of spontaneous hypoglycemia, commonly known as Whipple's triad, need more attention. OBJECTIVE Characterization and long-term follow-up of symptom development in patients with spontaneous hypoglycemia discharged as "healthy". The objective was to ascertain whether any conditions related to the symptoms were diagnosed during the follow-up period. METHODS Retrospective analysis of patient data and evaluation of a specific questionnaire on the development of symptoms of spontaneous hypoglycemia. In addition, patient questionnaires were evaluated and primary care physicians were asked about possible diseases not recorded at baseline that occurred during the follow-up period. SETTING Center for Endocrinology, Diabetology, and Osteology at the University Hospital Marburg, Inpatient Department, Germany. PATIENTS All patients who presented to our center for the 72-hour fast between 2005 and 2018 and were discharged without an internal medicine diagnosis were included. INTERVENTIONS Survey by questionnaire, via telephone interview. MAIN OUTCOME MEASURES Patient-reported information on current symptoms compared to original symptoms, diagnosis of insulinoma or diabetes mellitus during follow-up, matched with primary care physician data, and metabolic and biometric data such as body mass index (BMI), homeostasis model assessment for insulin resistance (HOMA IR), insulin sensitivity Matsuda Index (ISI-M), and area under the curve. RESULTS A total of 41 datasets were evaluated at baseline and 38 patients were followed for an average of approximately 10 years. In total, 61% of respondents still reported the same symptoms as at baseline. No insulinoma was missed in these patients. Only two of the 38 patients developed diabetes mellitus. CONCLUSION The high percentage of patients who are discharged as "healthy" and still have symptoms after many years is disturbing. It is possible that the symptoms are not due to low blood glucose. We urge caution with use of the term "healthy". We advocate a multidisciplinary therapeutic approach after an organic cause of hypoglycemia has been ruled out. Psychosomatic treatment seems to be useful. In addition, more research should be conducted on this topic.
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Affiliation(s)
- Jan Adelmeyer
- Center for Endocrinology, Diabetology & Osteology of Philipps, University Marburg, 35037, Marburg, Germany.
| | - Christian Marcel Schauer
- Center for Endocrinology, Diabetology & Osteology of Philipps, University Marburg, 35037, Marburg, Germany
| | - Peter Herbert Kann
- Center for Endocrinology, Diabetology & Osteology of Philipps, University Marburg, 35037, Marburg, Germany
- German Center for Endocrine Care (DEVZ), Düsseldorfer Str. 1-7, 60329, Frankfurt am Main, Germany
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Imamura S, Niwano F, Babaya N, Hiromine Y, Matsumoto I, Kamei K, Yoshida Y, Taketomo Y, Yoshida S, Takeyama Y, Noso S, Maeda N, Ikegami H. High Incidence of Diabetes Mellitus After Distal Pancreatectomy and Its Predictors: A Long-term Follow-up Study. J Clin Endocrinol Metab 2024; 109:619-630. [PMID: 37889837 PMCID: PMC10876401 DOI: 10.1210/clinem/dgad634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 10/29/2023]
Abstract
CONTEXT Glucose tolerance worsens after distal pancreatectomy (DP); however, the long-term incidence and factors affecting interindividual variation in this worsening are unclear. OBJECTIVE To investigate the changes in diabetes-related traits before and after DP and to clarify the incidence of diabetes and its predictors. METHODS Among 493 registered patients, 117 underwent DP. Among these, 56 patients without diabetes before surgery were included in the study. Glucose and endocrine function were prospectively assessed using a 75-g oral glucose tolerance test preoperatively, 1 month after DP, and every 6 months thereafter for up to 36 months. Pancreatic volumetry was performed using multidetector row computed tomography before and after surgery. RESULTS Insulin secretion decreased and blood glucose levels worsened after DP. Residual pancreatic volume was significantly associated with the reserve capacity of insulin secretion but not with blood glucose levels or the development of diabetes. Among 56 patients, 33 developed diabetes mellitus. The cumulative incidence of diabetes at 36 months after DP was 74.1%. Multivariate Cox regression analysis showed that impaired glucose tolerance as a preoperative factor as well as a decreased insulinogenic index and impaired glucose tolerance at 1 month postoperatively were identified as risk factors for diabetes following DP. CONCLUSION Impaired glucose tolerance and reduced early-phase insulin response to glucose are involved in the development of new-onset diabetes after DP; the latter is an additional factor in the development of diabetes and becomes apparent when pancreatic beta cell mass is reduced after DP.
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Affiliation(s)
- Shuzo Imamura
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Fumimaru Niwano
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Naru Babaya
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshihisa Hiromine
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yuta Yoshida
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yasunori Taketomo
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Sawa Yoshida
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Shinsuke Noso
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Norikazu Maeda
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
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Valsdottir TD, Øvrebø B, Kornfeldt TM, Litleskare S, Johansen EI, Henriksen C, Jensen J. Effect of aerobic exercise and low-carbohydrate high-fat diet on glucose tolerance and android/gynoid fat in overweight/obese women: A randomized controlled trial. Front Physiol 2023; 14:1056296. [PMID: 36760521 PMCID: PMC9902511 DOI: 10.3389/fphys.2023.1056296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
The study was designed to compare the effects of weight loss induced by a low-carbohydrate-high-fat diet or a normal diet, with and without exercise, on glucose tolerance measured as area under the curve (AUC), and android (A) and gynoid (G) fat distribution. The study was registered at clinicaltrials.gov; NCT04100356. In total, 57 women classified as overweight or obese (age 40 ± 3.5 years, body mass index 31.1 ± 2.6 kg/m2) were randomly assigned and completed a 10-week intervention using a low-carbohydrate high-fat diet or a normal diet, with or without aerobic interval exercise. An equal deficit of 700 kcal/day was prescribed, either restricting the diet only, or moderately restricting diet and including three 50-min high-intensity bicycle sessions per week. There were thus four groups: normal diet (NORM); low-carbohydrate-high-fat diet (LCHF); normal diet with exercise (NORM-EX); and low-carbohydrate-high-fat diet with exercise (LCHF-EX). Linear mixed models was used to assess differences between groups. With all groups pooled, the intervention resulted in a weight loss of 6.7 ± 2.5% (p < 0.001). The intervention did not result in differences between groups in AUC glucose, nor in fasting glucose or indicis for insulin resistance such as Homeostatic Model Assessment, Matsuda Insulin Sensitivity Index, insulinogenic index and disposition index. Post-intervention android fat was lower in LCHF than NORM (3,223 ± 727 vs. 2,533 ± 535 g, p = 0.041). LCHF reached a lower A/G ratio than NORM (0.94 ± 0.12 vs. 1.04 ± 0.09, p = 0.011) and LCHF-EX (0.94 ± 0.12 vs. 1.09 ± 0.09, p < 0.001) after the intervention. LCHF resulted in lower android fat mass compared to NORM and the lowest A/G ratio compared to the other matched groups, but with no accompanying improvement in AUC glucose. In conclusion, although all groups achieved improvements in glucose tolerance, no superior effect was observed with the LCHF diet, neither with nor without exercise.
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Affiliation(s)
- Thorhildur Ditta Valsdottir
- Institute of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway,Department of Health Sciences, Kristiania University College, Oslo, Norway,*Correspondence: Thorhildur Ditta Valsdottir,
| | - Bente Øvrebø
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Thea Martine Kornfeldt
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Sigbjørn Litleskare
- Department of Sports and Physical Education, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Egil Ivar Johansen
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| | - Christine Henriksen
- Institute of Basic Medical Sciences, Department of Nutrition, Faculty of Medicine University of Oslo, Oslo, Norway
| | - Jørgen Jensen
- Department of Health Sciences, Kristiania University College, Oslo, Norway
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Niwano F, Babaya N, Hiromine Y, Matsumoto I, Kamei K, Taketomo Y, Yoshida S, Takeyama Y, Noso S, Ikegami H. Three-Year Observation of Glucose Metabolism After Pancreaticoduodenectomy: A Single-Center Prospective Study in Japan. J Clin Endocrinol Metab 2022; 107:3362-3369. [PMID: 36074913 PMCID: PMC9693916 DOI: 10.1210/clinem/dgac529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The glucose tolerance of patients changes considerably from before to after pancreaticoduodenectomy wherein approximately half of the pancreas is resected. OBJECTIVE The aim of this prospective study was to investigate the incidence of and risk factors for diabetes after pancreaticoduodenectomy. METHODS This study is a part of an ongoing prospective study, the Kindai Prospective Study on Metabolism and Endocrinology after Pancreatectomy (KIP-MEP) study. Of the 457 patients enrolled to date, 96 patients without diabetes who underwent pancreaticoduodenectomy were investigated in this study. Preoperatively, 1 month post-pancreaticoduodenectomy, and every 6 months thereafter, the glucose metabolism and endocrine function were evaluated using the 75 g oral glucose tolerance test. Various other metabolic, endocrine, and exocrine indices were also examined over a period of up to 36 months. RESULTS Of the 96 patients analyzed in this study, 33 were newly diagnosed with diabetes. The cumulative diabetes incidence at 36 months following pancreaticoduodenectomy was 53.8%. The preoperative insulinogenic index and ΔC-peptide in the glucagon stimulation test were significantly lower in the progressors to diabetes than in the nonprogressors. Multivariate Cox regression analysis demonstrated that the insulinogenic index was the only significant risk factor for new-onset diabetes. CONCLUSION The majority of patients developed new-onset diabetes after pancreaticoduodenectomy, and a low value of the insulinogenic index was suggested to be a risk factor for diabetes. Preoperative assessment for the prediction of the onset of diabetes serves as useful information for patients and is important for postoperative glycemic control and diabetes management in patients who require pancreaticoduodenectomy.
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Affiliation(s)
- Fumimaru Niwano
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Naru Babaya
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshihisa Hiromine
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yasunori Taketomo
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Sawa Yoshida
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Shinsuke Noso
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Hiroshi Ikegami
- Correspondence: Hiroshi Ikegami, MD, PhD, Department of Endocrinology, Metabolism, and Diabetes, Kindai University Faculty of Medicine 377-2 Ohno-higashi, Osaka-sayama, Osaka 589-8511, Japan.
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Pistoia L, Meloni A, Allò M, Spasiano A, Messina G, Sorrentino F, Gamberini MR, Ermini A, Renne S, Fina P, Peritore G, Positano V, Pepe A, Cademartiri F. Relationship between pancreatic iron overload, glucose metabolism and cardiac complications in sickle cell disease: An Italian multicentre study. Eur J Haematol 2022; 109:289-297. [PMID: 35690882 DOI: 10.1111/ejh.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Evidence about the cross-talk between iron, glucose metabolism, and cardiac disease is increasing. We aimed to explore the link of pancreatic iron by Magnetic Resonance Imaging (MRI) with glucose metabolism and cardiac complications (CC) in sickle cell disease (SCD) patients. METHODS We considered 70 SCD patients consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Iron overload was quantified by R2* technique and biventricular function by cine images. Macroscopic myocardial fibrosis was evaluated by late gadolinium enhancement technique. Glucose metabolism was assessed by the oral glucose tolerance test. RESULTS Patients with an altered glucose metabolism showed a significantly higher pancreas R2* than patients with normal glucose metabolism. Pancreatic siderosis emerged as a risk factor for the development of metabolic alterations (OddsRatio 8.25, 95%confidence intervals 1.51-45.1; p = .015). Global pancreas R2* values were directly correlated with mean serum ferritin levels and liver iron concentration. Global pancreas R2* was not significantly associated with global heart R2* and macroscopic myocardial fibrosis. Patients with history of CC showed a significantly higher global pancreas R2* than patients with no CC. CONCLUSIONS Our findings support the evaluation of pancreatic R2* by MRI in SCD patients to prevent the development of metabolic and cardiac disorders.
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Affiliation(s)
- Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Massimo Allò
- Ematologia Microcitemia, Ospedale San Giovanni di Dio - ASP Crotone, Crotone, Italy
| | - Anna Spasiano
- U.O.S.D. Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Giuseppe Messina
- Centro Microcitemie, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesco Sorrentino
- U.O.S. Day Hospital Talassemici, Ospedale "Sant'Eugenio"- ASL Roma2, Rome, Italy
| | - Maria Rita Gamberini
- U. O. di Day Hospital della Talassemia e delle Emoglobinopatie. Dipartimento della Riproduzione e dell'Accrescimento, Azienda Ospedaliero-Universitaria "S. Anna", Ferrara, Italy
| | - Angela Ermini
- S.O.S. Immunoematologia e Medicina Trasfusionale Ospedale S. Maria Annunziata, Florence, Italy
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II", Lamezia Terme, Italy
| | - Priscilla Fina
- Unità Operativa Complessa Diagnostica per Immagini, Ospedale "Sandro Pertini", Rome, Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa di Radiologia, "ARNAS" Civico, Di Cristina Benfratelli, Palermo, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessia Pepe
- Department of Medicine, Institute of Radiology, University of Padua, Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
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Guerreiro V, Maia I, Neves JS, Salazar D, Ferreira MJ, Mendonça F, Silva MM, Borges-Canha M, Viana S, Costa C, Pedro J, Varela A, Lau E, Freitas P, Carvalho D. Oral glucose tolerance testing at 1 h and 2 h: relationship with glucose and cardiometabolic parameters and agreement for pre-diabetes diagnosis in patients with morbid obesity. Diabetol Metab Syndr 2022; 14:91. [PMID: 35794584 PMCID: PMC9258114 DOI: 10.1186/s13098-022-00865-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One hour plasma glucose concentration (1hPG) during an oral glucose tolerance test (OGTT) may be an alternative to 2-h plasma glucose concentration (2hPG) in the identification of individuals at increased risk of hyperglycaemia, although its role is not fully understood. AIM We aim to investigate the relationship of these measures with other glucose parameters, as well as their relationship with cardiometabolic risk markers and the level of agreement for prediabetes mellitus diagnosis, in a sample of patients with morbid obesity. METHODS We retrospectively evaluated 656 patients with morbid obesity without diagnosed diabetes. To define prediabetes with 2hPG, 2022 American Diabetes Association guidelines criteria were used, while for 1hPG, glucose ≥ 155 mg/dL was considered. Cohen's Kappa coefficient was used to assess the agreement between both measures of prediabetes mellitus diagnosis. RESULTS A Cohen's Kappa coefficient of 0.405 (p < 0.001) was obtained. The 1hPG were positively correlated with homeostatic model assessment for insulin resistance (HOMA-IR) (ρ = 0.281, p < 0.001), fasting plasma glucose (FPG) (ρ = 0.581, p < 0.001), glycated haemoglobin (Hb1AC) (ρ = 0.347, p < 0.001) and were negatively correlated with homeostatic model assessment for cell-β function (HOMA-β) (ρ = -0.092, p = 0.018). 2hPG were also correlated with the same parameters, except for HOMA-β. CONCLUSION A fair agreement between 1 and 2hPG was verified. 1hPG criteria may be a useful indicator of β-cell dysfunction and insulin resistance in patients with morbid obesity without diabetes diagnosis.
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Affiliation(s)
- Vanessa Guerreiro
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Isabel Maia
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Porto, Portugal
| | - João Sérgio Neves
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Daniela Salazar
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Maria João Ferreira
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Fernando Mendonça
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Maria Manuel Silva
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Marta Borges-Canha
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Consulta de Avaliação Multidisciplinar Do Tratamento Cirúrgico da Obesidade Do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Sara Viana
- Serviço de Medicina Interna, Unidade Local de Saúde Do Norte Alentejano, Portalegre, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia, Instituto Português de Oncologia, Porto, Portugal
| | - Jorge Pedro
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Ana Varela
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia, Porto, Portugal
| | - Eva Lau
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
- Consulta de Avaliação Multidisciplinar Do Tratamento Cirúrgico da Obesidade Do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Paula Freitas
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
- Consulta de Avaliação Multidisciplinar Do Tratamento Cirúrgico da Obesidade Do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Davide Carvalho
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
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da Silva Schreiber C, Rafacho A, Silverio R, Betti R, Lerário AC, Lotenberg AMP, Rahmann K, de Oliveira CP, Wajchenberg BL, da Luz PL. The effects of macronutrients composition on hormones and substrates during a meal tolerance test in drugnaive and sitagliptin-treated individuals with type 2 diabetes: a randomized crossover study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:2359-3997000000478. [PMID: 35551683 PMCID: PMC9832851 DOI: 10.20945/2359-3997000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022]
Abstract
Objective To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Methods Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543.
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Affiliation(s)
- Cristina da Silva Schreiber
- Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil,
- Present address: CSS is now at Endocrinology and Metabology Section, University Hospital professor Polydoro Ernani de São Thiago, UFSC, Florianópolis, Brazil. R.B. is now at Obesity and Diabetes Center Oswaldo Cruz Hospital Sao Paulo, São Paulo, Brazil. ACL is now at Clinic Hospital of the University of Sao Paulo Medical School, USP, São Paulo, Brazil
| | - Alex Rafacho
- Laboratório de Investigação em Doenças Crônicas (LIDoC), Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil,
| | - Renata Silverio
- Laboratório de Investigação em Doenças Crônicas (LIDoC), Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
| | - Roberto Betti
- Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
- Present address: CSS is now at Endocrinology and Metabology Section, University Hospital professor Polydoro Ernani de São Thiago, UFSC, Florianópolis, Brazil. R.B. is now at Obesity and Diabetes Center Oswaldo Cruz Hospital Sao Paulo, São Paulo, Brazil. ACL is now at Clinic Hospital of the University of Sao Paulo Medical School, USP, São Paulo, Brazil
| | - Antonio Carlos Lerário
- Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
- Present address: CSS is now at Endocrinology and Metabology Section, University Hospital professor Polydoro Ernani de São Thiago, UFSC, Florianópolis, Brazil. R.B. is now at Obesity and Diabetes Center Oswaldo Cruz Hospital Sao Paulo, São Paulo, Brazil. ACL is now at Clinic Hospital of the University of Sao Paulo Medical School, USP, São Paulo, Brazil
| | - Ana Maria Pita Lotenberg
- Laboratório de Lipídios (LIM10), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Klara Rahmann
- Laboratório de Lipídios (LIM10), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Carolina Piras de Oliveira
- Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Bernardo Léo Wajchenberg
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
- In memmoriam
| | - Protásio Lemos da Luz
- Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
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8
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Sanchez-Rodriguez E, Vazquez-Aguilar LA, Biel-Glesson S, Fernandez-Navarro JR, Espejo-Calvo JA, Olmo-Peinado JM, de la Torre R, Fito-Colomer M, Covas MI, Romero C, Brenes M, Martinez de Victoria E, Gil A, Mesa MD. May bioactive compounds from the olive fruit improve the postprandial insulin response in healthy adults? J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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9
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Anoop S, Jebasingh K F, Philip DM, Kurian ME, Mohan V, Finney G, Thomas N. The waist-height ratio is a potential anthropometric index of insulin resistance: Observations based on oral glucose tolerance test in lean, normo-glycaemic, Asian Indian males from Southern India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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10
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Kuo FY, Cheng KC, Li Y, Cheng JT. Oral glucose tolerance test in diabetes, the old method revisited. World J Diabetes 2021; 12:786-793. [PMID: 34168728 PMCID: PMC8192259 DOI: 10.4239/wjd.v12.i6.786] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/24/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023] Open
Abstract
The oral glucose tolerance test (OGTT) has been widely used both in clinics and in basic research for a long time. It is applied to diagnose impaired glucose tolerance and/or type 2 diabetes mellitus in individuals. Additionally, it has been employed in research to investigate glucose utilization and insulin sensitivity in animals. The main aim of each was quite different, and the details are also somewhat varied. However, the time or duration of the OGTT was the same, using the 2-h post-glucose load glycemia in both, following the suggestions of the American Diabetes Association. Recently, the use of 30-min or 1-h post-glucose load glycemia in clinical practice has been recommended by several studies. In this review article, we describe this new view and suggest perspectives for the OGTT. Additionally, quantification of the glucose curve in basic research is also discussed. Unlike in clinical practice, the incremental area under the curve is not suitable for use in the studies involving animals receiving repeated treatments or chronic treatment. We discuss the potential mechanisms in detail. Moreover, variations between bench and bedside in the application of the OGTT are introduced. Finally, the newly identified method for the OGTT must achieve a recommendation from the American Diabetes Association or another official unit soon. In conclusion, we summarize the recent reports regarding the OGTT and add some of our own perspectives, including machine learning and others.
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Affiliation(s)
- Feng Yu Kuo
- Cardiovascular Center, Veterans General Hospital, Kaohsiung 82445, Taiwan
| | - Kai-Chun Cheng
- Department of Pharmacy, College of Pharmacy and Health Care, Tajen University, Pingtung 90741, Taiwan
- Pharmacological Department of Herbal Medicine and Department of Psychosomatic Internal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8544, Japan
| | - Yingxiao Li
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 973302, Taiwan
| | - Juei-Tang Cheng
- Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan
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11
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Pepe A, Pistoia L, Gamberini MR, Cuccia L, Peluso A, Messina G, Spasiano A, Allò M, Bisconte MG, Putti MC, Casini T, Dello Iacono N, Celli M, Vitucci A, Giuliano P, Peritore G, Renne S, Righi R, Positano V, De Sanctis V, Meloni A. The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications in Thalassemia Major: A Large, Multicenter Observational Study. Diabetes Care 2020; 43:2830-2839. [PMID: 32887708 DOI: 10.2337/dc20-0908] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We systematically explored the link of pancreatic iron with glucose metabolism and with cardiac complications in a cohort of 1,079 patients with thalassemia major (TM) enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. RESEARCH DESIGN AND METHODS MRI was used to quantify iron overload (T2* technique) and cardiac function (cine images) and to detect macroscopic myocardial fibrosis (late gadolinium enhancement technique). Glucose metabolism was assessed by the oral glucose tolerance test (OGTT). RESULTS Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with impaired fasting glucose, impaired glucose tolerance, and diabetes. A pancreas T2* <13.07 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for disturbances of glucose metabolism and for cardiac iron. Patients with myocardial fibrosis showed significantly lower pancreas T2* values. Patients with cardiac complications had significantly lower pancreas T2* values. No patient with arrhythmias/heart failure had a normal global pancreas T2*. CONCLUSIONS Pancreatic iron is a powerful predictor not only for glucose metabolism but also for cardiac iron and complications, supporting the close link between pancreatic iron and heart disease and the need to intensify iron chelation therapy to prevent both alterations of glucose metabolism and cardiac iron accumulation.
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Affiliation(s)
- Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Maria Rita Gamberini
- Dipartimento della Riproduzione e dell'Accrescimento, Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, Ferrara, Italy
| | - Liana Cuccia
- Unità Operativa Complessa Ematologia con Talassemia, Azienda di Rilievo Nazionale ed Alta Specializzazione Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Angelo Peluso
- Struttura Semplice di Microcitemia, Ospedale "SS. Annunziata" ASL Taranto, Taranto, Italy
| | - Giuseppe Messina
- Centro Microcitemie, Azienda Ospedaliera "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "Antonio Cardarelli," Napoli, Italy
| | - Massimo Allò
- Ematologia Microcitemia, Ospedale San Giovanni di Dio-Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maria Grazia Bisconte
- Centro di Microcitemia, Unità Operativa Ematologia, Azienda Ospedaliera Cosenza, Cosenza, Italy
| | - Maria Caterina Putti
- Clinica di Emato-Oncologia Pediatrica, Dipartimento di Salute della Donna e del Bambino, Azienda Ospedaliero di Padova-Università di Padova, Padova, Italy
| | - Tommaso Casini
- Centro Talassemie ed Emoglobinopatie, Ospedale "Meyer," Firenze, Italy
| | - Nicola Dello Iacono
- Centro Microcitemia, Day Hospital Thalassemia, Poliambulatorio "Giovanni Paolo II," Ospedale Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Mauro Celli
- Unità Operativa Complessa di ImmunoEmatologia, Dipartimenti Assistenziali Integrati di Pediatria e Neuropsiachiatria Infantile, Roma, Italy
| | - Angelantonio Vitucci
- Ematologia con Trapianto-Servizio Regionale Talassemie, Dipartimento dell'Emergenza e dei Trapianti d'Organo, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Bari, Italy
| | - Pietro Giuliano
- Cardiologia con UTIC, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa di Radiologia, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II," Lamezia Terme, Italy
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, Lagosanto, Italy
| | - Vincenzo Positano
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Antonella Meloni
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
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12
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Pham H, Holen IS, Phillips LK, Hatzinikolas S, Huynh LQ, Wu T, Hausken T, Rayner CK, Horowitz M, Jones KL. The Effects of a Whey Protein and Guar Gum-Containing Preload on Gastric Emptying, Glycaemia, Small Intestinal Absorption and Blood Pressure in Healthy Older Subjects. Nutrients 2019; 11:nu11112666. [PMID: 31694157 PMCID: PMC6893806 DOI: 10.3390/nu11112666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
A whey protein/guar gum preload reduces postprandial glycaemia in type 2 diabetes through slowing gastric emptying. However, gastric emptying has previously been assessed using a stable isotope breath test technique, which cannot discriminate between slowing of gastric emptying and small intestinal absorption. This preload also may be useful in the management of postprandial hypotension. We evaluated the effects of a whey protein/guar preload on gastric emptying, glucose absorption, glycaemic/insulinaemic and blood pressure (BP) responses to an oral glucose load. Eighteen healthy older participants underwent measurements of gastric emptying (scintigraphy), plasma glucose and insulin, glucose absorption, superior mesenteric artery (SMA) flow, BP and heart rate (HR) after ingesting a 50 g glucose drink, with or without the preload. The preload reduced plasma glucose (p = 0.02) and serum 3-O-methylglucose (3-OMG) (p = 0.003), and increased plasma insulin (p = 0.03). There was no difference in gastric emptying or BP between the two days. The reduction in plasma glucose on the preload day was related to the reduction in glucose absorption (r = 0.71, p = 0.002). In conclusion, the glucose-lowering effect of the preload may relate to delayed small intestinal glucose absorption and insulin stimulation, rather than slowing of gastric emptying.
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Affiliation(s)
- Hung Pham
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
| | - Iselin S. Holen
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; (I.S.H.); (T.H.)
| | - Liza K. Phillips
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Seva Hatzinikolas
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
| | - Lian Q. Huynh
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
| | - Tongzhi Wu
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Trygve Hausken
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway; (I.S.H.); (T.H.)
| | - Christopher K. Rayner
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Karen L. Jones
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia; (H.P.); (L.K.P.); (S.H.); (L.Q.H.); (T.W.); (C.K.R.); (M.H.)
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, Australia
- Correspondence: ; Tel.: +61-8-8313-7821
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