New frontiers in the treatment of diabetic dyslipidemia

Monascus yellow, red and orange pigments from red yeast rice ameliorate lipid metabolic disorders and gut microbiota dysbiosis in Wistar rats fed on a high-fat diet

This study aimed to compare the hypolipidaemic activities of different Monascus pigments (yellow, red and orange pigments) and elucidate their possible regulatory mechanisms on lipid and cholesterol metabolism in rats fed on a high-fat diet (HFD). Results showed that oral administrations of Monascus yellow, red and orange pigments can markedly alleviate the disturbance of lipid metabolism through ameliorating the serum lipid levels and suppressing hepatic lipid accumulation and steatosis. Meanwhile, the excretion of fecal cholesterol, triacylglycerols and bile acids was also promoted by the oral administrations of different Monascus pigments (MPs). Furthermore, Monascus pigment (MP) supplementation produced significant structural changes in the intestinal microbiota of HFD-fed rats, and modulated the relative abundance of functionally related microbial phylotypes compared with the HFD group in particular. Key phylotypes in response to the HFD and Monascus pigment (MP) intervention were found to strongly correlate with the lipid metabolism disorder associated parameters using Spearman's correlation coefficient. Some beneficial gut microbiota (such as Oscillibacter sp., Ruminococcus albus, Clostridium sp., etc.) were found to be negatively correlated with the serum and hepatic lipid indicator. Moreover, Monascus pigment (MP) treatments regulated the mRNA expression levels of the genes responsible for lipid and cholesterol metabolism. In general, different Monascus pigments (MPs) regulate the homeostasis of lipid and cholesterol metabolism through different regulatory pathways. These findings illustrated that not only Monascus yellow pigments, but also Monascus red and orange pigments have the potential to ameliorate lipid metabolic disorders, and therefore could be used as potential functional food ingredients for the prevention or treatment of hyperlipidemia and gut microbiota dysbiosis.

Characteristics of lipid profiles and lipid control in patients with diabetes in a tertiary hospital in Southwest China: an observational study based on electronic medical records

Background

Diabetes is often accompanied by dyslipidemia. Lipid control is very important in the management of diabetes. There are limited real world data on the lipid control in diabetic inpatients in southwest China.

Methods

An observational study was conducted to assess the characteristics of lipid profiles and lipid control. Diabetic patients from February 2009 to December 2013 at West China Hospital of Sichuan University were identified.

Results

A total of 56,784 inpatients were included and 85.9% of them had at least one lipid panel. The proportions of inpatients with optimal low-density lipoprotein cholesterol (LDL-C) level (< 2.59 mmol/L), optimal triglyceride (TG) level (< 1.70 mmol/L), optimal high-density lipoprotein cholesterol (HDL-C) level (men ≥1.04 mmol/L; women ≥1.30 mmol/L) and optimal non-high-density lipoprotein cholesterol (non-HDL-C) level (< 3.37 mmol/L) were 61.1, 64.6, 49.9 and 64.5%, respectively. Only 23.1% of inpatients obtained optimal levels for all the above four lipid parameters. Of diabetic inpatients with ischemic heart disease, the proportions of inpatients with optimal LDL-C level (< 1.81 mmol/L), optimal TG level (< 1.70 mmol/L), optimal HDL-C level (men ≥1.04 mmol/L; women ≥1.30 mmol/L) and optimal non-HDL-C level (< 2.59 mmol/L) were 38.0, 66.3, 48.1 and 48.7%, respectively. Of diabetic inpatients with cerebrovascular disease, the proportions were 28.3, 64.8, 49.9 and 38.1%, respectively. Older people and men were more likely to obtain optimal lipid levels. However, inpatients between 46 and 64 years were least likely to obtain optimal LDL-C levels.

Conclusions

The lipid control of diabetic inpatients in southwest China is worrisome. Individualized strategies of lipid management should be taken to bridge the gap between the recommendations of clinical guidelines and the real situation of clinical practice.

Electronic supplementary material

The online version of this article (10.1186/s12944-018-0945-8) contains supplementary material, which is available to authorized users.

Triglycerides Revisited to the Serial

This review discusses the role of triglycerides (TGs) in the normal cardiovascular system as well as in the development and clinical manifestation of cardiovascular diseases. Regulation of TGs at the enzymatic and genetic level, in addition to their possible relevance as preclinical and clinical biomarkers, is discussed, culminating with a description of available and emerging treatments. Due to the high complexity of the subject and the vast amount of material in the literature, the objective of this review was not to exhaust the subject, but rather to compile the information to facilitate and improve the understanding of those interested in this topic. The main publications on the topic were sought out, especially those from the last 5 years. The data in the literature still give reason to believe that there is room for doubt regarding the use of TG as disease biomarkers; however, there is increasing evidence for the role of hypertriglyceridemia on the atherosclerotic inflammatory process, cardiovascular outcomes, and mortality.

Targeting metabolic disorders by natural products

The most prevalent metabolic disorders are diabetes mellitus, obesity, dyslipidemia, osteoporosis and metabolic syndrome, which are developed when normal metabolic processes are disturbed. The most common pathophysiologies of the above disorders are oxidative stress, Nrf2 pathways, epigenetic, and change in miRNA expression. There is a challenge in the prevention and treatment of metabolic disorders due to severe adverse effects of some synthetic drugs, their high cost, lack of safety and poverty in some conditions, and insufficient accessibility for the general population in the world. With increasing interest in shifting from synthetic drugs to phytotherapy as an alternative treatment, there is still a gap in scientific evidences of plant-derived therapeutic benefits. One reason may be slow rate of translation of animal studies' findings into human clinical trials. Since metabolic disorders are multifactorial, it seems that poly-herbal medications, or drug-herbal combination are needed for their treatment. However, further researches to determine the most effective plant-derived metabolites, and their cellular mechanism in order to set priorities for well-designed animal and clinical trials, and also more studies with strong scientific evidences such as systematic review and meta-analysis of controlled studies are needed.