Evaluation of the hypothalamic-pituitary-adrenal axis in a case series of familial partial lipodystrophy

The interplay between leptin, glucocorticoids, and GLP1 regulates food intake and feeding behaviour

Nutritional, endocrine, and neurological signals converge in multiple brain centres to control feeding behaviour and food intake as part of the allostatic regulation of energy balance. Among the several neuroendocrine systems involved, the leptin, glucocorticoid, and glucagon-like peptide 1 (GLP1) systems have been extensively researched. Leptin is at the top hierarchical level since its complete absence is sufficient to trigger severe hyperphagia. Glucocorticoids are key regulators of the energy balance adaptation to stress and their sustained excess leads to excessive adiposity and metabolic perturbations. GLP1 participates in metabolic adaptation to food intake, regulating insulin secretion and satiety by parallel central and peripheral signalling systems. Herein, we review the brain and peripheral targets of these three hormone systems that integrate to regulate food intake, feeding behaviour, and metabolic homeostasis. We examine the functional relationships between leptin, glucocorticoids, and GLP1 at the central and peripheral levels, including the cross-regulation of their circulating levels and their cooperative or antagonistic actions at different brain centres. The pathophysiological roles of these neuroendocrine systems in dysregulated intake are explored in the two extremes of body adiposity - obesity and lipodystrophy - and eating behaviour disorders.

Global prevalence of sexual dysfunction in cardiovascular patients: a systematic review and meta-analysis

BACKGROUND

Sexual dysfunction poses a significant challenge for patients with cardiac conditions. Concerning the prevalence of sexual disorders in cardiovascular patients, several seminal studies conducted in various regions of the world have provided diverse facts and figures pertaining to sexual dysfunction among cardiovascular patients. Therefore, the present study aimed to analyze, summarize, and integrate the findings of seminal studies on the effect of underlying factors and estimate the global rate of sexual disorders in cardiovascular patients.

METHODS

The present systematic review and meta-analysis included studies conducted in 2003-2023. To find the relevant published academic papers, SID, MagIran, PubMed, Scopus, Web of Science (WOS), and Google Scholar databases were searched for keywords using MeSH/Emtree until January 14, 2023. The GRADEpro software was used to evaluate the quality of evidence. The heterogeneity of studies was checked using the I2 index.

RESULTS

An initial number of 2122 studies were found in the first search. Following a precise screening process based on predefined inclusion criteria, a total of 17 studies were deemed suitable for inclusion in the meta-analysis. The global prevalence of sexual disorders in cardiovascular patients was estimated at 62.6% (95% CI: 49.8-73.8%). As the results of the meta-regression showed that as the sample size increased, there was a significant decrease in the overall prevalence of sexual disorders among cardiovascular patients. Additionally, as the study years progressed, both age and JBI score exhibited an upward trend.

CONCLUSION

The present findings showed a high prevalence of sexual disorders among cardiovascular patients. Therefore, it is recommended that experts and health policymakers enhance their focus on effectively preventing and controlling these disorders. Besides the evidence achieved very low certainty, it is important for the treatment team to prioritize the sexual relations of cardiovascular patients and focus on improving their sexual function. This should be seen as an essential aspect of their overall recovery process.

The role of adipokines and ghrelin in interactions and clinical implications in childhood obesity

BACKGROUND

Childhood obesity is a growing global health concern, especially prevalent in the Arabian Peninsula, and is known to contribute to metabolic syndrome and insulin resistance. This study aimed to investigate the interplay between adipokines (leptin and adiponectin), ghrelin, and insulin homeostasis in childhood obesity.

MATERIAL AND METHODS

A case-control study was conducted in Babylon involving 120 children/adolescents (7-17 years). The participants were divided into two groups: 60 obese and 60 healthy controls. Anthropometric and biochemical measures were examined, applying World Health Organization (WHO) growth standards to categorize weight status. Data on blood lipids, glucose, adipokines, and ghrelin were collected in Babylon (Merjan Medical City), ensuring accuracy and providing insights into pediatric obesity's metabolic and hormonal status.

RESULT

Clinical, anthropometric, and laboratory attributes of children were evaluated, with classification as normal-weight or obese based on BMI/Z-score and Waist Circumference. The obese group exhibited elevated triglycerides and insulin levels, as well as reduced adiponectin levels (P ≤ 0.001). Leptin levels showed a positive correlation with BMI/Z-score (r = 0.352, P = 0.006). A diagnostic model demonstrated the significant diagnostic capacity of leptin (AUC > 99%) and its importance in predicting childhood obesity. Each unit increase in leptin elevated the probability of obesity by a factor of 1.197 (95% CI: 1.0507-1.3632, P = 0.0068).

CONCLUSION

The study revealed significant differences in clinical, biochemical, and biological markers of obesity between the research groups and the control group. Leptin emerged as a significant predictor of obesity, demonstrating high diagnostic accuracy. The complex interactions among these adipokines underscore the necessity for comprehensive obesity management strategies.

Susceptibility to hypertension based on MTHFR rs1801133 single nucleotide polymorphism and MTHFR promoter methylation

Background

The aetio-pathologenesis of hypertension is multifactorial, encompassing genetic, epigenetic, and environmental factors. The combined effect of genetic and epigenetic changes on hypertension is not known. We evaluated the independent and interactive association of MTHFR rs1801133 single nucleotide polymorphism (SNP) and MTHFR promoter methylation with hypertension among Taiwanese adults.

Methods

We retrieved data including, MTHFR promoter methylation, MTHFR rs1801133 genotypes (CC, CT, and TT), basic demography, personal lifestyle habits, and disease history of 1,238 individuals from the Taiwan Biobank (TWB).

Results

The distributions of hypertension and MTHFR promoter methylation quartiles (β < 0.1338, 0.1338 ≤ β < 0.1385, 0.1385 ≤ β < 0.1423, and β ≥ 0.1423 corresponding to

Conclusion

Independently, rs1801133 TT was associated with a higher risk of hypertension, but methylation was not. Based on genotypes, lower methylation was dose-dependently associated with a higher risk of hypertension in individuals with the CC genotype. Our findings suggest that MTHFR rs1801133 and MTHFR promoter methylation could jointly influence hypertension susceptibility.

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Key Words

• MTHFR
• hypertension
• interaction
• promoter methylation
• rs1801133
• susceptibility

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Affiliation(s)

Ming-Huang Chiu Department of Pulmonology and Respiratory Care, Cathay General Hospital, Taipei City, Taiwan
Chia-Hsiu Chang Cardiovascular Center, Cathay General Hospital, Taipei City, Taiwan
Disline Manli Tantoh Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
Tsui-Wen Hsu Superintendent Office, Institute of Medicine, Cathay General Hospital, Taipei City, Taiwan
Chih-Hsuan Hsiao Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
Ji-Han Zhong Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
Yung-Po Liaw Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan

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Concurrent alteration in inflammatory biomarker gene expression and oxidative stress: how aerobic training and vitamin D improve T2DM

Background

Vitamin D (Vit D) supplementation and Aerobic Training (AT) exert several beneficial effects such as antioxidant and anti-inflammatory actions. The literature on the effects of AT and Vit D supplementation on the oxidative stress biomarkers and gene expression of inflammatory cytokines in patients with Type 2 Diabetes Mellitus (T2DM) is limited. The present study aimed to examine the effects of AT and Vit D supplementation on inflammation and oxidative stress signaling pathways in T2DM patients.

Materials and methods

In this single-blinded, randomized, placebo-controlled trial, 48 men with T2DM (aged 35–50 years with Body Mass Index (BMI) of 25–30 kg/m2) were randomly allocated into four groups: AT+Vit D (n = 10); AT + placebo (AT; n = 10); Vit D (n = 10), and Control + placebo (C; n = 10). The eight-week AT program was executed for 20–40 min/day, at 60–75% of heart rate maximum (HRmax), for 3 days/wks. The Vit D group received 50,000 IU of Vit D supplement capsules per week for 8 weeks. The serum levels of oxidative stress biomarkers and gene expression of inflammatory cytokines in the Peripheral Blood Mononuclear Cells (PBMCs) were evaluated using the RT-PCR method. To analyze the data, paired t-tests and one-way analysis of variance and Tukey’s post hoc test were used at the significance level of P < 0.05.

Results

The result shows that serum 25-OH-Vit D, total nitrite, Total Glutathione (GSH), Total Antioxidant Capacity (TAC), Superoxide Dismutase (SOD), Catalase (CAT), and Glutathione Peroxidase (GPX) increased; and insulin, Fasting Blood Glucose (FBG), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), High Sensitivity C-Reactive Protein (hs-CRP), Malondialdehyde (MDA), glycated albumin, and Urinary 8-hydroxydeoxyguanine (8-OHdG) decreased significantly in all groups after 8 weeks, except for C. In addition, results of RT-PCR showed that AT+Vit D, Vit D, and AT significantly downregulated the gene expression of Tumor Necrosis Factor-Alpha (TNF-α), Interleukin-1 Beta (IL-1β), Mitogen-Activated Protein Kinases 1 (MAPK1), Nuclear Factor Kappa B (NF-κB) 1 (p50). It also upregulated Interleukin-4 (IL-4) gene expression, Peroxisome Proliferator-Activated Receptor Gamma (PPAR-γ) in T2DM patients compared to the C.

Conclusion

Additionally, the AT+Vit D group showed significantly lower insulin, FBG, HOMA-IR, hs-CRP, MDA, glycated albumin, urinary 8-OHdG, IL-1β, TNF-α, MAPK1, and NF-κB1 (p50) levels and significantly higher serum 25-OH-Vit D, total nitrite, GSH, TAC, CAT, SOD, GPX, IL-4, and PPAR-γ levels compared to the AT and Vit D groups. In T2DM patients, 8 weeks of AT+Vit D had a more significant impact on certain gene expressions related to inflammation and oxidative stress than Vit D or AT alone.

Relative fat mass assessment estimates changes in adiposity among female older adults with obesity after a 12-month exercise and diet intervention

BACKGROUND/OBJECTIVES/INTRODUCTION

It is imperative to accurately estimate whole body fat percentage (%fat) to understand the deleterious nature of excess adiposity on cardiometabolic disease risk. Cost and accessibility often preclude the use of advanced imaging methods like dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). Relative fat mass (RFM) is an emerging estimator of whole body %fat based on waist circumference, height, and biological sex. The purpose of this ancillary study was to examine the relationship between RFM and gold-standard measures of adiposity among community-dwelling older adults with obesity and to evaluate if changes in RFM reflect changes in %fat following a 12-month lifestyle intervention (clinicaltrials.gov #NCT00955903).

PATIENTS/MATERIALS AND METHODS

Participants (N = 163, 37.4% male, 70.3 ± 4.7 years) were randomized to the exercise only group, exercise + nutrient-dense weight maintenance group, or exercise + nutrient-dense energy restriction of 500 kcal/d group. Total and regional adiposity assessed by DXA and MRI, as well as anthropometrics, were evaluated at baseline and 12 months.

RESULTS

RFM was significantly positively correlated with DXA whole body %fat and DXA trunk %fat at baseline. Equivalence testing revealed that RFM was considered equivalent to DXA whole body %fat for females only. Additionally, from baseline to 12 months, a significant reduction in RFM was observed among female participants in the exercise + energy restriction group only. Changes in RFM were significantly correlated with changes in DXA whole body %fat, DXA trunk fat, and total abdominal fat tissue determined by MRI.

CONCLUSION

Results support the use of RFM as an estimate of whole body %fat where advanced imaging techniques are not feasible. Furthermore, results suggest that this index is sensitive to changes in fat mass over 12 months in female older adults with obesity. KEY MESSAGESRelative fat mass (RFM), an emerging estimator of whole body %fat based on waist circumference, height, and biological sex, was intentionally developed to be a simple estimate of adiposity that overcomes limitations of measures like body mass index.In the current study, results from correlations and agreement analyses support the use of RFM to estimate whole-body fat percentage in a community-dwelling older adult population with obesity when advanced methods, namely dual-energy X-ray absorptiometry, are not feasible.Significant reductions in RFM were also observed over a 12-month period that was significantly correlated with changes in whole body fat percentage; thus, supporting the sensitivity of RFM to lifestyle changes.

Relationship among health-related quality of life and global ancestry, clinical and socioeconomic factors in type 1 diabetes in an admixed Brazilian population

We aimed to evaluate the Health-related quality of life (HRQoL) of Type 1 diabetes mellitus (T1D) patients in an admixed Brazilian population. This is a cross-sectional study with 152 T1D patients. HRQoL information was obtained from two self-completed questionnaires: Short Form-6 dimensions and EuroQol-5 dimensions with visual analog scale. For inference of global ancestry, the panel of 46 autosomal informational insertion/deletion ancestry markers was used. Demographic and socioeconomic data, presence of chronic complications, glycemic control level, and type of treatment were obtained. Patients with good HRQoL were: male, under 18 years old, had health insurance, less than 5 years of diagnosis, practiced physical activity, without hypoglycemia in the last 30 days, absence of retinopathy and nephropathy, a participant in educational activities, used analogous insulin, monitoring blood glucose, observed maximum adherence to treatment and came from the secondary service. Global ancestry and self-reported color/race did not influence HRQoL indexes. Our study is the first to measure HRQoL, global ancestry and recognize the impact of T1D on the lives of patients in the State of Maranhão, Brazil. The results validate the need to provide T1D patients with continuous training on self-management and self-monitoring, aiming for better results in metabolic control and, subsequently, in the prevention of acute and chronic complications, in order to generate positive impacts on the quality of life of this population. We understand that global ancestry in a highly mixed population such as ours did not influence the HRQoL of these patients.

Cardiovascular protective effects of PPARγ agonists in hypothyroid rats: protection against oxidative stress

Hypothyroidism disturbs redox homeostasis and takes part in cardiovascular system dysfunction. Considering antioxidant and cardio-protective effects of PPAR-γ agonists including pioglitazone (POG) and rosiglitazone (RSG), the present study was aimed to determine the effect of POG or RSG on oxidants and antioxidants indexes in the heart and aorta tissues of Propylthiouracil (PTU)-induced hypothyroid rats.

MATERIALS AND METHODS

The animals were divided into six groups: (1) Control; (2) propylthiouracil (PTU), (3) PTU-POG 10, (4) PTU-POG 20, (5) PTU-RSG 2, and (6) PTU-RSG 4. Hypothyroidism was induced in rats by giving 0.05% propylthiouracil (PTU) in drinking water for 42 days. The rats of PTU-POG 10 and PTU-POG 20 groups received 10 and 20 mg/kg POG, respectively, besides PTU, and the rats of PTU-RSG 2 and PTU-RSG 4 groups received 2 and 4 mg/kg RSG, respectively, besides PTU. The animals were sacrificed, and the serum of the rats was collected to measure thyroxine level. The heart and aorta tissues were also removed for the measurement of biochemical oxidative stress markers.

RESULTS

Hypothyroidism was induced by PTU administration, which was indicated by lower serum thyroxine levels. Hypothyroidism also was accompanied by a decrease of catalase (CAT), superoxide dismutase (SOD) activities, and thiol concentration in the heart and aorta tissues while increased level of malondialdehyde (MDA). Interestingly, administration of POG or RSG dramatically reduced oxidative damage in the heart and aorta, as reflected by a decrease in MDA and increased activities of SOD, CAT, and thiol content.

CONCLUSION

The results of this study showed that administration of POG or RSG decreased oxidative damage in the heart and aorta tissues induced by hypothyroidism in rats.

Obesity and male infertility: multifaceted reproductive disruption

Background

The global prevalence of obesity has soared to a concerning height in the past few decades. Interestingly, the global decline in semen quality is a parallel occurrence that urges researchers to evaluate if obesity is among the most essential causatives of male infertility or subfertility.

Main body

Obesity may alter the synchronized working of the reproductive-endocrine milieu, mainly the hypothalamic-pituitary-gonadal (HPG) axis along with its crosstalks with other reproductive hormones. Obesity-mediated impairment in semen parameters may include several intermediate factors, which include physical factors, essentially increased scrotal temperature due to heavy adipose tissue deposits, and systemic inflammation and oxidative stress (OS) initiated by various adipose tissue-derived pro-inflammatory mediators. Obesity, via its multifaceted mechanisms, may modulate sperm genetic and epigenetic conformation, which severely disrupt sperm functions. Paternal obesity reportedly has significant adverse effects upon the outcome of assisted reproductive techniques (ARTs) and the overall health of offspring. Given the complexity of the underlying mechanisms and rapid emergence of new evidence-based hypotheses, the concept of obesity-mediated male infertility needs timely updates and pristine understanding.

Conclusions

The present review comprehensively explains the possible obesity-mediated mechanisms, especially via physical factors, OS induction, endocrine modulation, immune alterations, and genetic and epigenetic changes, which may culminate in perturbed spermatogenesis, disrupted sperm DNA integrity, compromised sperm functions, and diminished semen quality, leading to impaired male reproductive functions.

Fat-free/lean body mass in children with insulin resistance or metabolic syndrome: a systematic review and meta-analysis

BACKGROUND

Lean / Fat Free Body Mass (LBM) is metabolically involved in active processes such as resting energy expenditure, glucose uptake, and myokine secretion. Nonetheless, its association with insulin sensitivity / resistance / glucose tolerance and metabolic syndrome remains unclear in childhood.

METHODS

The current investigation aimed to examine the differences in fat-free mass /lean body mass according to the presence of insulin sensitivity/insulin resistance/glucose tolerance/metabolic syndrome in children. A systematic search was carried out in Medline/PubMed, Embase, Scopus, Web of Science, and SciELO, covering the period from each database's respective start to 21 June 2021. Two researchers evaluated 7111 studies according to the inclusion criteria: original human studies, written in English or Spanish, evaluating fat-free mass/lean body mass in children and adolescents including both with and without insulin sensitivity/insulin resistance /glucose tolerance and metabolic syndrome and reported the differences between them in terms of fat free mass/lean body mass. The results of the studies were combined with insulin sensitivity, insulin, resistance, glucose tolerance and metabolic syndrome. The standardized mean difference (SMD) in each study was calculated and combined using the random-effects model. Heterogeneity between studies was tested using the index of heterogeneity (I2), leave-one-out sensitivity analyses were performed, and publication bias was assessed using the Egger and Begg tests.

RESULTS

Finally, 15 studies which compared groups defined according to different glucose homeostasis criteria or metabolic syndrome out of 103 eligible studies were included in this systematic review and 12 studies in the meta-analysis. Meta-analysis showed lower fat-free mass/lean body mass percentage in participants with insulin resistance/glucose tolerance/metabolic syndrome (SMD -0.47; 95% CI, - 0.62 to - 0.32) while in mass units (kg), higher values were found in the same group (SMD, 1.01; 95% CI, 0.43 to 1.60).

CONCLUSIONS

Our results identified lower values of fat-free mass/lean body mass (%) in children and adolescents with insulin resistance/glucose tolerance/metabolic syndrome and higher values of fat-free mass/lean body mass when these are expressed in kg. The evidence of the impact of lean mass on children's glucose homeostasis or metabolic syndrome is limited, so future studies research should focus on explaining the effect of fat-free mass/lean body mass on different metabolic outcomes. Moreover, it may be interesting to evaluate the quality (muscle density) or functional (muscle strength) outcomes in addition to both absolute (kg) and relative (%) values in future studies. The systematic review was prospectively registered at PROSPERO (registration number CRD42019124734; available at: http://www.crd.york.ac.uk/prospero [accessed: 05 April 2019]).

Responses of different functional tests in candidates for bariatric surgery and the association with body composition, metabolic and lipid profile

Individuals with obesity can have metabolic disorders and may develop impairments that affect the ability to exercise. The maximal incremental cardiopulmonary exercise test is widely used to assess functional capacity. However, submaximal tests such as the two-minute step test (2MST) and the six-minute walk test (6MWT) also allow this assessment. We propose to analyze whether body composition, metabolic and lipid profile influence the maximal and submaximal performance, and investigate these variables in response to different functional tests. Forty-four individuals with obesity, aged 18–50 years, underwent analysis of body composition, metabolic and lipid profile, incremental treadmill test (ITMT), 6MWT, and 2MST. One-way ANOVA, Pearson or Spearman correlation, and Stepwise multiple linear regression analysis were performed. ITMT induced a greater metabolic, ventilatory, cardiovascular, and perceived exertion demand when compared to the 6MWT and 2MST (p < 0.05). In addition, 2MST elicited a higher chronotropic (HR) and metabolic (V̇O₂) demand when compared to the 6MWT (p < 0.05). Significant correlations were found between tests and body composition, metabolic and lipid profile. Fat mass and low-density lipoprotein can explain 30% of the V̇O₂ variance in the ITMT; and fat mass, glucose, and performance in the 2MST can explain 42% of the variance of the distance walked in the ITMT. Obesity and its metabolic impairments are capable of influencing responses to exercise. ITMT generated greater demand due to the high stress imposed, however, 2MST demanded greater metabolic and chronotropic demand when compared to the 6MWT.