Genetic predisposition to dyslipidemia and type 2 diabetes risk in two prospective cohorts

Causal relationship between dyslipidemia and diabetic neuropathy: a mendelian randomization study

Some studies have shown an association between dyslipidemia and diabetic neuropathy (DN), but the genetic association has not been clarified. Therefore, the present study aimed to investigate the genetic causal association between dyslipidemia and DN through a Mendelian randomization (MR) approach. Genetic causal associations between total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL), and high-density lipoprotein cholesterol (HDL) and DN were investigated by MR to provide a basis for the prevention and treatment of DN. Significant and independent single-nucleotide polymorphisms (SNPs) identified in genome-wide association studies were selected as instrumental variables (IVs) for MR analysis. Inverse variance weighted (IVW), MR‒Egger regression, weighted median (WME), simple mode (SM), and weighted mode (WM) methods were used to analyze causal associations. Heterogeneity and multiplicity tests were also performed and analyzed using the leave-one-out method to assess the stability of the results. Genetically predicted TC and DN (OR = 0.793, 95% CI = 0.655⁓0.961, P = 0.019) and LDL and DN (OR = 0.842, 95% CI = 0.711⁓0.998, P = 0.049) may be causally associated, but no causal associations were found between TG and DN (OR = 0.837, 95% CI = 0.631⁓1.111, P = 0.221) or between HDL and DN (OR = 1.192, 95% CI = 0.940⁓1.510, P = 0.149). TC and LDL may have genetic causal associations with DN, though no genetic causal associations were found for TG or HDL with DN. However, this study may have several limitations, and further clinical studies are needed to expand the sample size for future validation.

Investigation of the risk factors associated with prediabetes in normal-weight Qatari adults: a cross-sectional study

Type 2 diabetes is one of the most prevalent chronic diseases in the world, and more people than ever before have impaired glucose tolereance, or prediabetes. Many patients with impaired glucose tolerance and undiagnosed diabetes do not know that their glucose metabolism system has been in a state of disorder. Every year, about 5-10% of prediabetics develop diabetes. One of the important achieving factors may be the increase in blood lipids. However, it is not clear whether triglyceride is associated with impaired glucose tolerance and prediabetes in the Qatari population. Therefore, we investigated the relationship between the first several clinical variables and prediabetes status in normal and overweight populations. We conducted a cross-sectional study using data from the Qatar Biobank program. The study included 5,996 participants who were adults over the age of 20. We collected information about participants' fasting blood glucose levels with other clinical measurements and used various machine learning models and logistic regression to study the association between the clinical measurements and prediabetes for normal and overobese weight groups. The use of several machine learning models showed that, after adjusting the potential confounding factors such as age and sex, Triglyceride has been demonstrated to be positively correlated with prediabetes, and there was a special population dependence phenomenon. Among them, nonobese people (p < 0.05). The effect value and 95% confidence interval and OR of triglyceride on prediabetes was 2.79 and (e0.78, e1.28), respectively.

Interaction Between Primary Hyperlipidemias and Type 2 Diabetes: Therapeutic Implications

There is a gap of knowledge about the clinical and pathophysiological implications resulting from the interaction between primary hyperlipidemias and type 2 diabetes (T2D). Most of the existing evidence comes from sub-analyses of cohorts; scant information derives from randomized clinical trials. The expected clinical implications of T2D in patients with primary hyperlipidemias is an escalation of their already high cardiovascular risk. There is a need to accurately identify patients with this dual burden and to adequately prescribe lipid-lowering therapies, with the current advancements in newer therapeutic options. This review provides an update on the interactions of primary hyperlipidemias, such as familial combined hyperlipidemia, familial hypercholesterolemia, multifactorial chylomicronemia, lipoprotein (a), and type 2 diabetes.

The Association Between the Triglyceride to High-Density Lipoprotein Cholesterol Ratio and the Incidence of Type 2 Diabetes Mellitus in the Japanese Population

Abstract Aims: To explore whether the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) was independently associated with the risk of incident type 2 diabetes mellitus (T2DM) in a large Japanese cohort. Methods: A secondary analysis was performed using open-access data from a retrospective cohort study. A total of 12,716 eligible participants who had standard medical examinations at the Murakami Memorial Hospital were included in this study. New-onset T2DM was the main outcome during follow-up. The risk of T2DM based on the TG/HDL-C ratio was evaluated using Cox regression analysis and Kaplan-Meier analysis. Subgroup analysis was performed to understand further the significance of the TG/HDL-C ratio in particular populations. To assess the potential of the TG/HDL-C ratio for predicting T2DM, a receiver operating characteristic (ROC) analysis was performed. Results: One hundred fifty new-onset T2DM cases were observed during a median follow-up of 5.39 years. The incidence of T2DM increased with a rise in the TG/HDL-C ratio based on the Kaplan-Meier curves (P < 0.0001). After controlling for potential confounding variables, the TG/HDL-C ratio was positively related to incidence of T2DM (hazard ratio = 1.08, 95% confidence interval: 1.01-1.15, P = 0.0239). In subgroup analysis, those with a body mass index of ≥18.5 and <24 kg/m2 showed a significantly positive relationship. The area under the ROC curve for the TG/HDL-C ratio as a T2DM predictor was 0.684. The optimal TG/HDL-C ratio cutoff value for T2DM was 1.609, with a sensitivity of 54.7% and a specificity of 73.6%. Conclusion: The authors' results showed a significant relationship between the TG/HDL-C ratio and the incidence of T2DM in the Japanese population.

Changes in Haematological Parameters and Lipid Profiles in Diabetes Mellitus: A Literature Review

Diabetes mellitus is a metabolic disorder characterized by elevated blood glucose that has sequelae on cellular, haematological, and metabolic parameters, including lipid profile disturbed homeostasis, which manifest in alterations in haematological parameters and lipid profiles. These changes in haematological parameters and lipid profiles have been reported by previous research; however, the pattern of these changes and their correlation have not been elucidated. This review aims to assess these changes and investigate the degree of correlation between haematological parameters and lipid profiles in patients with type 2 diabetes mellitus (T2DM). The method adopted was a traditional review approach that included a narrative of concepts and a critical assessment of a few selected articles. Findings highlight that haematological parameters and lipid profiles show varied alterations and correlations in T2DM. For instance, statistical significances at p < 0.05 are reported for WBC count (r = -0.75) showing negative correlations (p < 0.001), where RBC count (r = 0.56) showed correlation with high-density lipoprotein cholesterol (HDLC), whereas anaemia (packed cell volume: r = -0.51) and RBC indices (mean corpuscular volume: r = -0.75; mean corpuscular haemoglobin: r = -089) show negative correlations with total cholesterol (TC). The specific haematological parameters, namely, RBC and WBC with differential and platelet counts, as well as indices, showed varied changes and correlation with lipid profiles, namely, HDLC, low-density lipoprotein cholesterol, TC, and triglyceride, in the six reviewed articles. Diabetes is characterized by changes in haematological parameters and lipid profiles. A better understanding of the negative and positive correlating changes could be utilized in routine evaluation of subjects with prediabetes as well as managing complications in diabetes. Correlation between haematological parameters and lipid profiles over the course of diabetes progression using HbA1c as an index of glucose control is necessary for additional empirical data and updates.

Age effect on the shared etiology of glycemic traits and serum lipids: evidence from a Chinese twin study

PURPOSE

Diabetes and dyslipidemia are among the most common chronic diseases with increasing global disease burdens, and they frequently occur together. The study aimed to investigate differences in the heritability of glycemic traits and serum lipid indicators and differences in overlapping genetic and environmental influences between them across age groups.

METHODS

This study included 1189 twin pairs from the Chinese National Twin Registry and divided them into three groups: aged ≤ 40, 41-50, and > 50 years old. Univariate and bivariate structural equation models (SEMs) were conducted on glycemic indicators and serum lipid indicators, including blood glucose (GLU), glycated hemoglobin A1c (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), in the total sample and three age groups.

RESULTS

All phenotypes showed moderate to high heritability (0.37-0.64). The heritability of HbA1c demonstrated a downward trend with age (HbA1c: 0.50-0.79), while others remained relatively stable (GLU: 0.55-0.62, TC: 0.58-0.66, TG: 0.50-0.63, LDL-C: 0.24-0.58, HDL-C: 0.31-0.57). The bivariate SEMs demonstrated that GLU and HbA1c were correlated with each serum lipid indicator (0.10-0.17), except HDL-C. Except for HbA1c and LDL-C, as well as HbA1c and HDL-C, differences in genetic correlations underlying glycemic traits and serum lipids between age groups were observed, with the youngest group showing a significantly higher genetic correlation than the oldest group.

CONCLUSION

Across the whole adulthood, genetic influences were consistently important for GLU, TC, TG, LDL-C and HDL-C, and age may affect the shared genetic influences between glycemic traits and serum lipids. Further studies are needed to elucidate the role of age in the interactions of genes related to glycemic traits and serum lipids.

Predictive model for early detection of type 2 diabetes using patients' clinical symptoms, demographic features, and knowledge of diabetes

Background and Aims

With the global rise in type 2 diabetes, predictive modeling has become crucial for early detection, particularly in populations with low routine medical checkup profiles. This study aimed to develop a predictive model for type 2 diabetes using health check-up data focusing on clinical details, demographic features, biochemical markers, and diabetes knowledge.

Methods

Data from 444 Nigerian patients were collected and analysed. We used 80% of this data set for training, and the remaining 20% for testing. Multivariable penalized logistic regression was employed to predict the disease onset, incorporating waist-hip ratio (WHR), triglycerides (TG), catalase, and atherogenic indices of plasma (AIP).

Results

The predictive model demonstrated high accuracy, with an area under the curve of 99% (95% CI = 97%-100%) for the training set and 94% (95% CI = 89%-99%) for the test set. Notably, an increase in WHR (adjusted odds ratio [AOR] = 70.35; 95% CI = 10.04-493.1, p-value < 0.001) and elevated AIP (AOR = 4.55; 95% CI = 1.48-13.95, p-value = 0.008) levels were significantly associated with a higher risk of type 2 diabetes, while higher catalase levels (AOR = 0.33; 95% CI = 0.22-0.49, p < 0.001) correlated with a decreased risk. In contrast, TG levels (AOR = 1.04; 95% CI = 0.40-2.71, p-value = 0.94) were not associated with the disease.

Conclusion

This study emphasizes the importance of using distinct clinical and biochemical markers for early type 2 diabetes detection in Nigeria, reflecting global trends in diabetes modeling, and highlighting the need for context-specific methods. The development of a web application based on these results aims to facilitate the early identification of individuals at risk, potentially reducing health complications, and improving diabetes management strategies in diverse settings.

Allostatic load in early adolescence: gene / environment contributions and relevance for mental health

Background

Allostatic load is the cumulative "wear and tear" on the body due to chronic adversity. We aimed to test poly-environmental (exposomic) and polygenic contributions to allostatic load and their combined contribution to early adolescent mental health.

Methods

We analyzed data on N = 5,035 diverse youth (mean age 12) from the Adolescent Brain Cognitive Development Study (ABCD). Using dimensionality reduction method, we calculated and overall allostatic load score (AL) using body mass index [BMI], waist circumference, blood pressure, blood glycemia, blood cholesterol, and salivary DHEA. Childhood exposomic risk was quantified using multi-level environmental exposures before age 11. Genetic risk was quantified using polygenic risk scores (PRS) for metabolic system susceptibility (type 2 diabetes [T2D]) and stress-related psychiatric disease (major depressive disorder [MDD]). We used linear mixed effects models to test main, additive, and interactive effects of exposomic and polygenic risk (independent variables) on AL (dependent variable). Mediation models tested the mediating role of AL on the pathway from exposomic and polygenic risk to youth mental health. Models adjusted for demographics and genetic principal components.

Results

We observed disparities in AL with non-Hispanic White youth having significantly lower AL compared to Hispanic and Non-Hispanic Black youth. In the diverse sample, childhood exposomic burden was associated with AL in adolescence (beta=0.25, 95%CI 0.22-0.29, P<.001). In European ancestry participants (n=2,928), polygenic risk of both T2D and depression was associated with AL (T2D-PRS beta=0.11, 95%CI 0.07-0.14, P<.001; MDD-PRS beta=0.05, 95%CI 0.02-0.09, P=.003). Both polygenic scores showed significant interaction with exposomic risk such that, with greater polygenic risk, the association between exposome and AL was stronger. AL partly mediated the pathway to youth mental health from exposomic risk and from MDD-PRS, and fully mediated the pathway from T2D-PRS.

Conclusions

AL can be quantified in youth using anthropometric and biological measures and is mapped to exposomic and polygenic risk. Main and interactive environmental and genetic effects support a diathesis-stress model. Findings suggest that both environmental and genetic risk be considered when modeling stress-related health conditions.

Metabolic drivers of dysglycemia in pregnancy: ethnic-specific GWAS of 146 metabolites and 1-sample Mendelian randomization analyses in a UK multi-ethnic birth cohort

Introduction

Gestational diabetes mellitus (GDM) is the most common pregnancy complication worldwide and is associated with short- and long-term health implications for both mother and child. Prevalence of GDM varies between ethnicities, with South Asians (SAs) experiencing up to three times the risk compared to white Europeans (WEs). Recent evidence suggests that underlying metabolic difference contribute to this disparity, but an investigation of causality is required.

Methods

To address this, we paired metabolite and genomic data to evaluate the causal effect of 146 distinct metabolic characteristics on gestational dysglycemia in SAs and WEs. First, we performed 292 GWASs to identify ethnic-specific genetic variants associated with each metabolite (P ≤ 1 x 10-5) in the Born and Bradford cohort (3688 SA and 3354 WE women). Following this, a one-sample Mendelian Randomisation (MR) approach was applied for each metabolite against fasting glucose and 2-hr post glucose at 26-28 weeks gestation. Additional GWAS and MR on 22 composite measures of metabolite classes were also conducted.

Results

This study identified 15 novel genome-wide significant (GWS) SNPs associated with tyrosine in the FOXN and SLC13A2 genes and 1 novel GWS SNP (currently in no known gene) associated with acetate in SAs. Using MR approach, 14 metabolites were found to be associated with postprandial glucose in WEs, while in SAs a distinct panel of 11 metabolites were identified. Interestingly, in WEs, cholesterols were the dominant metabolite class driving with dysglycemia, while in SAs saturated fatty acids and total fatty acids were most commonly associated with dysglycemia.

Discussion

In summary, we confirm and demonstrate the presence of ethnic-specific causal relationships between metabolites and dysglycemia in mid-pregnancy in a UK population of SA and WE pregnant women. Future work will aim to investigate their biological mechanisms on dysglycemia and translating this work towards ethnically tailored GDM prevention strategies.

Deep Learning Framework for Complex Disease Risk Prediction Using Genomic Variations

Genome-wide association studies have proven their ability to improve human health outcomes by identifying genotypes associated with phenotypes. Various works have attempted to predict the risk of diseases for individuals based on genotype data. This prediction can either be considered as an analysis model that can lead to a better understanding of gene functions that underlie human disease or as a black box in order to be used in decision support systems and in early disease detection. Deep learning techniques have gained more popularity recently. In this work, we propose a deep-learning framework for disease risk prediction. The proposed framework employs a multilayer perceptron (MLP) in order to predict individuals' disease status. The proposed framework was applied to the Wellcome Trust Case-Control Consortium (WTCCC), the UK National Blood Service (NBS) Control Group, and the 1958 British Birth Cohort (58C) datasets. The performance comparison of the proposed framework showed that the proposed approach outperformed the other methods in predicting disease risk, achieving an area under the curve (AUC) up to 0.94.

Atherosclerosis indexes and incident T2DM in middle-aged and older adults: evidence from a cohort study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is an expanding global health problem, requiring effective methods for predicting and diagnosing in its early stages of development. Previous studies reported the prognostic value of the atherosclerosis indexes in both cardiovascular diseases and T2DM. However, the predictive performance of Non-HDL-C, AI, AIP, TG/HDL-C and LCI indexes on the risk of T2DM remains unclear. This study aims to compare the five atherosclerosis indexes for predicting T2DM in middle-aged and elderly Chinese.

METHODS

Data are collected from wave 2011 and wave 2015 of China Health and Retirement Longitudinal Study (CHARLS). Multi-variate logistic regression models were used to estimate odds ratio (OR) with 95% confidence interval (CI) of incident T2DM with five atherosclerosis indexes, and the restricted cubic splines were used to visualize the dose-response relationships. Receiver operating characteristic (ROC) curve was drawn and the areas under the curve (AUC) were used to compare the performance of the five atherosclerosis indexes in predicting T2DM.

RESULTS

A total of 504 (10.97%) participants had T2DM. Multi-variate logistic regression analysis showed that five atherosclerosis indexes were associated with T2DM, with adjusted ORs (95% CIs) of 1.29 (1.15-1.45), 1.29 (1.18-1.42), 1.45 (1.29-1.62), 1.41 (1.25-1.59) and 1.34 (1.23-1.48) for each IQR increment in Non-HDL-C, TG/HDLC, AI, AIP and LCI, respectively. Restricted cubic spline regression showed a nonlinear correlation between five atherosclerosis indexes and the risk of T2DM (p for nonlinear < 0.001). According to the ROC curve analysis, LCI had the highest AUC (0.587 [0.574-0.600]).

CONCLUSION

We found that LCI, compared with other indexes, was a better predictor in the clinical setting for identifying individuals with T2DM in middle-aged and elderly Chinese. LCI monitoring might help in the early identification of individuals at high risk of T2DM.

Investigating sex-specific associations of lipid traits with type 2 diabetes, glycemic traits and sex hormones using Mendelian randomization

BACKGROUND

Low-density lipoprotein (LDL)-cholesterol is positively associated with cardiovascular disease (CVD) and inversely associated with type 2 diabetes, which could detract from lipid modification. Here, we examined whether lipid traits potentially relevant to CVD aetiology, i.e. apolipoprotein B (apoB), triglycerides (TG) and lipoprotein(a) [Lp(a)] exhibited the same associations. We investigated sex-specifically, including the role of sex hormones, because sex disparities exist in lipid profile and type 2 diabetes. We also replicated where possible.

METHODS

We used Mendelian randomization (MR) to examine sex-specific associations of apoB, TG and Lp(a) with type 2 diabetes, HbA1c, fasting insulin, fasting glucose, testosterone and estradiol in the largest relevant sex-specific genome-wide association studies (GWAS) in people of European ancestry and replicated where possible. We also assessed sex-specific associations of liability to type 2 diabetes with apoB, TG and Lp(a).

RESULTS

Genetically predicted apoB and Lp(a) had little association with type 2 diabetes or glycemic traits in women or men. Genetically predicted higher TG was associated with higher type 2 diabetes risk [odds ratio (OR) 1.44 per standard deviation (SD), 95% confidence interval (CI) 1.26 to 1.65], HbA1c and fasting insulin specifically in women. Higher TG was associated with lower testosterone in women and higher testosterone in men, but with lower estradiol in men and women. Genetic liability to type 2 diabetes was associated with higher TG in women, and possibly with lower apoB in men.

CONCLUSIONS

Lipid traits potentially relevant to CVD aetiology do not exhibit contrasting associations with CVD and type 2 diabetes. However, higher TG is associated with higher type 2 diabetes risk and glycemic traits, which in turn further increases TG specifically in women, possibly driven by sex hormones.

Lipid-induced glucose intolerance is driven by impaired glucose kinetics and insulin metabolism in healthy individuals

AIMS

Hypertriglyceridemia is associated with an increased risk of type 2 diabetes. We aimed to comprehensively examine the effects of hypertriglyceridemia on major glucose homeostatic mechanisms involved in diabetes progression.

METHODS

In this randomized, cross-over, single-blinded study, two dual-labeled, 3-hour oral glucose tolerance tests were performed during 5-hour intravenous infusions of either 20 % Intralipid or saline in 12 healthy subjects (age 27.9 ± 2.6 years, 11 men, BMI 22.6 ± 1.4 kg/m²) to evaluate lipid-induced changes in insulin metabolism and glucose kinetics. Insulin sensitivity, β cell secretory function, and insulin clearance were assessed by modeling glucose, insulin and C-peptide data. Intestinal glucose absorption, endogenous glucose production, and glucose clearance were assessed from glucose tracers. The effect of triglycerides on β-cell secretory function was examined in perifusion experiments in murine pseudoislets and human pancreatic islets.

RESULTS

Mild acute hypertriglyceridemia impaired oral glucose tolerance (mean glucose: +0.9 [0.3, 1.5] mmol/L, p = 0.008) and whole-body insulin sensitivity (Matsuda index: -1.67 [-0.50, -2.84], p = 0.009). Post-glucose hyperinsulinemia (mean insulin: +99 [17, 182] pmol/L, p = 0.009) resulted from reduced insulin clearance (-0.16 [-0.32, -0.01] L min^-1 m^-2, p = 0.04) and enhanced hyperglycemia-induced total insulin secretion (+11.9 [1.1, 22.8] nmol/m², p = 0.02), which occurred despite a decline in model-derived β cell glucose sensitivity (-41 [-74, -7] pmol min^-1 m^-2 mmol^-1 L, p = 0.04). The analysis of tracer-derived glucose metabolic fluxes during lipid infusion revealed lower glucose clearance (-96 [-152, -41] mL/kg_FFM, p = 0.005), increased 2-hour oral glucose absorption (+380 [42, 718] μmol/kg_FFM, p = 0.04) and suppressed endogenous glucose production (-448 [-573, -123] μmol/kg_FFM, p = 0.005). High-physiologic triglyceride levels increased acute basal insulin secretion in murine pseudoislets (+11 [3, 19] pg/aliquot, p = 0.02) and human pancreatic islets (+286 [59, 512] pg/islet, p = 0.02).

CONCLUSION

Our findings support a critical role for hypertriglyceridemia in the pathogenesis of type 2 diabetes in otherwise healthy individuals and dissect the glucose homeostatic mechanisms involved, encompassing insulin sensitivity, β cell function and oral glucose absorption.

Macronutrient intake modulates impact of EcoRI polymorphism of ApoB gene on lipid profile and inflammatory markers in patients with type 2 diabetes

We sought to examine whether dietary intakes may affect the relationship between ApoB EcoRI and lipid profile, as well as serum inflammatory markers, in patients with type 2 diabetes (T2DM). This current study consisted of 648 diabetic patients. Dietary intake was calculated by a food frequency questionnaire. Biochemical markers (high-density lipoprotein (HDL), total cholesterol (TC), LDL, TG, CRP, IL-18, PGF2α) were measured based on standard protocols. Genotyping of the Apo-B polymorphisms (rs1042031) was conducted by the PCR–RFLP method. The gene-diet interactions were evaluated using GLMs. In comparison to GG homozygotes, A-allele carriers with above the median -CHO intake (≥ 54 percent of total energy) had considerably greater TC and PGF2a concentrations. Furthermore, as compared to GG homozygotes, A-allele carriers with above the median protein intake (≥ 14 percent of total energy) had higher serum levels of TG (P = 0.001), CRP (P = 0.02), TG/HDL (P = 0.005), and LDL/HDL (P = 0.04) ratios. Moreover, A-allele carriers with above the median total fat intake (≥ 35 percent of total calories) had significantly higher TC level (P = 0.04) and LDL/HDL (P = 0.04) ratios compared to GG homozygotes. Furthermore, when compared to GG homozygotes, A-allele carriers who consumed above the median cholesterol (> 196 mg) had greater TG (P = 0.04), TG/HDL (P = 0.01) ratio, and IL-18 (P = 0.02). Furthermore, diabetic patients with the GA, AA genotype who consume above the median cholesterol had lower ghrelin levels (P = 0.01). In terms of LDL/HDL ratio, ApoB EcoRI and dietary intakes of specific fatty acids (≥ 9 percent for SFA and ≥ 12 percent for MUFA) had significant interaction. LDL/HDL ratio is greater in A-allele carriers with above the median SFA intake (P = 0.04), also when they consumed above the median MUFA this association was inverse (P = 0.04). Our study showed that plasma lipid levels in participants carrying the (AA or AG) genotype were found to be more responsive to increasing the percentage of energy derived from dietary fat, CHO, protein, SFA, and cholesterol consumption. Therefore, patients with a higher genetic susceptibility (AA or AG) seemed to have greater metabolic markers with a higher percentage of macronutrient consumption. Also, ApoB EcoRI correlations with metabolic markers might be attenuated with above the median MUFA consumption.

A Lipid Signature with Perturbed Triacylglycerol Co-Regulation, Identified from Targeted Lipidomics, Predicts Risk for Type 2 Diabetes and Mediates the Risk from Adiposity in Two Prospective Cohorts of Chinese Adults

BACKGROUND

The roles of individual and co-regulated lipid molecular species in the development of type 2 diabetes (T2D) and mediation from metabolic risk factors remain unknown.

METHODS

We conducted profiling of 166 plasma lipid species in 2 nested case-control studies within 2 independent cohorts of Chinese adults, the Dongfeng-Tongji and the Jiangsu non-communicable disease cohorts. After 4.61 (0.15) and 7.57 (1.13) years' follow-up, 1039 and 520 eligible participants developed T2D in these 2 cohorts, respectively, and controls were 1:1 matched to cases by age and sex.

RESULTS

We found 27 lipid species, including 10 novel ones, consistently associated with T2D risk in the 2 cohorts. Differential correlation network analysis revealed significant correlations of triacylglycerol (TAG) 50:3, containing at least one oleyl chain, with 6 TAGs, at least 3 of which contain the palmitoyl chain, all downregulated within cases relative to controls among the 27 lipids in both cohorts, while the networks also both identified the oleyl chain-containing TAG 50:3 as the central hub. We further found that 13 of the 27 lipids consistently mediated the association between adiposity indicators (body mass index, waist circumference, and waist-to-height ratio) and diabetes risk in both cohorts (all P < 0.05; proportion mediated: 20.00%, 17.70%, and 17.71%, and 32.50%, 28.73%, and 33.86%, respectively).

CONCLUSIONS

Our findings suggested notable perturbed co-regulation, inferred from differential correlation networks, between oleyl chain- and palmitoyl chain-containing TAGs before diabetes onset, with the oleyl chain-containing TAG 50:3 at the center, and provided novel etiological insight regarding lipid dysregulation in the progression from adiposity to overt T2D.

Circulating Metabolic Biomarkers Are Consistently Associated With Type 2 Diabetes Risk in Asian and European Populations

CONTEXT

While Asians have a higher risk of type 2 diabetes (T2D) than Europeans for a given body mass index (BMI), it remains unclear whether the same markers of metabolic pathways are associated with diabetes.

OBJECTIVE

We evaluated associations between metabolic biomarkers and incidence of T2D in 3 major Asian ethnic groups (Chinese, Malay, and Indian) and a European population.

METHODS

We analyzed data from adult males and females of 2 cohorts from Singapore (n = 6393) consisting of Chinese, Malays, and Indians and 3 cohorts of European-origin participants from Finland (n = 14 558). We used nuclear magnetic resonance to quantify 154 circulating metabolic biomarkers at baseline and performed logistic regression to assess associations with T2D risk adjusted for age, sex, BMI and glycemic markers.

RESULTS

Of the 154 metabolic biomarkers, 59 were associated with higher risk of T2D in both Asians and Europeans (P < 0.0003, Bonferroni-corrected). These included branched chain and aromatic amino acids, the inflammatory marker glycoprotein acetyls, total fatty acids, monounsaturated fatty acids, apolipoprotein B, larger very low-density lipoprotein particle sizes, and triglycerides. In addition, 13 metabolites were associated with a lower T2D risk in both populations, including omega-6 polyunsaturated fatty acids and larger high-density lipoprotein particle sizes. Associations were consistent within the Asian ethnic groups (all Phet ≥ 0.05) and largely consistent for the Asian and European populations (Phet ≥ 0.05 for 128 of 154 metabolic biomarkers).

CONCLUSION

Metabolic biomarkers across several biological pathways were consistently associated with T2D risk in Asians and Europeans.

Lipid traits and type 2 diabetes risk in African ancestry individuals: A Mendelian Randomization study

BACKGROUND

Dyslipidaemia is highly prevalent in individuals with type 2 diabetes mellitus (T2DM). Numerous studies have sought to disentangle the causal relationship between dyslipidaemia and T2DM liability. However, conventional observational studies are vulnerable to confounding. Mendelian Randomization (MR) studies (which address this bias) on lipids and T2DM liability have focused on European ancestry individuals, with none to date having been performed in individuals of African ancestry. We therefore sought to use MR to investigate the causal effect of various lipid traits on T2DM liability in African ancestry individuals.

METHODS

Using univariable and multivariable two-sample MR, we leveraged summary-level data for lipid traits and T2DM liability from the African Partnership for Chronic Disease Research (APCDR) (N = 13,612, 36.9% men) and from African ancestry individuals in the Million Veteran Program (Ncases = 23,305 and Ncontrols = 30,140, 87.2% men), respectively. Genetic instruments were thus selected from the APCDR after which they were clumped to obtain independent instruments. We used a random-effects inverse variance weighted method in our primary analysis, complementing this with additional sensitivity analyses robust to the presence of pleiotropy.

FINDINGS

Increased genetically proxied low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels were associated with increased T2DM liability in African ancestry individuals (odds ratio (OR) [95% confidence interval, P-value] per standard deviation (SD) increase in LDL-C = 1.052 [1.000 to 1.106, P = 0.046] and per SD increase in TC = 1.089 [1.014 to 1.170, P = 0.019]). Conversely, increased genetically proxied high-density lipoprotein cholesterol (HDL-C) was associated with reduced T2DM liability (OR per SD increase in HDL-C = 0.915 [0.843 to 0.993, P = 0.033]). The OR on T2DM per SD increase in genetically proxied triglyceride (TG) levels was 0.884 [0.773 to 1.011, P = 0.072] . With respect to lipid-lowering drug targets, we found that genetically proxied 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) inhibition was associated with increased T2DM liability (OR per SD decrease in genetically proxied LDL-C = 1.68 [1.03-2.72, P = 0.04]) but we did not find evidence of a relationship between genetically proxied proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition and T2DM liability.

INTERPRETATION

Consistent with MR findings in Europeans, HDL-C exerts a protective effect on T2DM liability and HMGCR inhibition increases T2DM liability in African ancestry individuals. However, in contrast to European ancestry individuals, LDL-C may increase T2DM liability in African ancestry individuals. This raises the possibility of ethnic differences in the metabolic effects of dyslipidaemia in T2DM.

FUNDING

See the Acknowledgements section for more information.

Positive association between the ratio of triglycerides to high-density lipoprotein cholesterol and diabetes incidence in Korean adults

BACKGROUND

Insulin resistance is associated with the incidence of diabetes and cardiovascular diseases such as myocardial infarction. The ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) (TG/HDL-C ratio) is positively correlated with insulin resistance. This study aimed to investigate the relationship between the TG/HDL-C ratio and the incidence of diabetes in Korean adults.

METHODS

This retrospective study used data from the National Health Insurance Service-National Health Screening Cohort. The TG/HDL-C ratio was divided into three tertiles, the T₁, T₂, and T₃ groups, based on sex. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetes using multivariate Cox proportional hazards regression analyses.

RESULTS

A total of 80,693 subjects aged between 40 and 79 years were enrolled. The median follow-up period was 5.9 years. The estimated cumulative incidence of diabetes in the T₁, T₂, and T₃ groups was 5.94%, 8.23%, and 13.50%, respectively, in men and 4.12%, 4.72%, and 6.85%, respectively, in women. Compared to T₁, the fully adjusted HRs (95% CIs) of the T₂ and T₃ groups for new-onset diabetes were 1.17 (1.06-1.30) and 1.47 (1.34-1.62), respectively, in men and 1.20 (1.02-1.42) and 1.52 (1.30-1.78), respectively, in women.

CONCLUSIONS

Increased TG/HDL-C ratio was significantly associated with a higher risk of new-onset diabetes in both sexes.

In-depth analysis reveals complex molecular aetiology in a cohort of idiopathic cerebral palsy

Cerebral palsy is the most prevalent physical disability in children; however, its inherent molecular mechanisms remain unclear. In the present study, we performed in-depth clinical and molecular analysis on 120 idiopathic cerebral palsy families, and identified underlying detrimental genetic variants in 45% of these patients. In addition to germline variants, we found disease-related postzygotic mutations in ∼6.7% of cerebral palsy patients. We found that patients with more severe motor impairments or a comorbidity of intellectual disability had a significantly higher chance of harbouring disease-related variants. By a compilation of 114 known cerebral-palsy-related genes, we identified characteristic features in terms of inheritance and function, from which we proposed a dichotomous classification system according to the expression patterns of these genes and associated cognitive impairments. In two patients with both cerebral palsy and intellectual disability, we revealed that the defective TYW1, a tRNA hypermodification enzyme, caused primary microcephaly and problems in motion and cognition by hindering neuronal proliferation and migration. Furthermore, we developed an algorithm and demonstrated in mouse brains that this malfunctioning hypermodification specifically perturbed the translation of a subset of proteins involved in cell cycling. This finding provided a novel and interesting mechanism for congenital microcephaly. In another cerebral palsy patient with normal intelligence, we identified a mitochondrial enzyme GPAM, the hypomorphic form of which led to hypomyelination of the corticospinal tract in both human and mouse models. In addition, we confirmed that the aberrant Gpam in mice perturbed the lipid metabolism in astrocytes, resulting in suppressed astrocytic proliferation and a shortage of lipid contents supplied for oligodendrocytic myelination. Taken together, our findings elucidate novel aspects of the aetiology of cerebral palsy and provide insights for future therapeutic strategies.

Dysfunctional High-Density Lipoproteins in Type 2 Diabetes Mellitus: Molecular Mechanisms and Therapeutic Implications

High density lipoproteins (HDLs) are commonly known for their anti-atherogenic properties that include functions such as the promotion of cholesterol efflux and reverse cholesterol transport, as well as antioxidant and anti-inflammatory activities. However, because of some chronic inflammatory diseases, such as type 2 diabetes mellitus (T2DM), significant changes occur in HDLs in terms of both structure and composition. These alterations lead to the loss of HDLs' physiological functions, to transformation into dysfunctional lipoproteins, and to increased risk of cardiovascular disease (CVD). In this review, we describe the main HDL structural/functional alterations observed in T2DM and the molecular mechanisms involved in these T2DM-derived modifications. Finally, the main available therapeutic interventions targeting HDL in diabetes are discussed.

The influence of VDR polymorphisms on the type 2 diabetes susceptibility in Chinese: an interaction with hypertriglyceridemia

Evidence shows that mutations in vitamin D receptor (VDR) have been linked with an increased risk of type 2 diabetes (T2D). However, the interaction effect between VDR variants and environmental factors on the T2D susceptibility remained unclear. Therefore, the current study was conducted to explore the joint effect of VDR polymorphisms and serum triglyceride level on T2D. A total of 2017 participants were included in the cross-sectional study. Taqman probe assays were applied to rs3847987 and rs739837 genotyping. Multiple logistic regression and general linear model were used to examine the effect of interaction between VDR variants and TG on T2D susceptibility and fasting serum glucose, respectively. The results showed that rs739837 polymorphism was significantly associated with an increased risk of T2D under the dominant model (OR = 1.30, 95% CI 1.02-1.66), after adjusting for potential risk factors. Meanwhile, there was a significant additive interaction between rs3847987 and hypertriglyceridemia (synergy index [SI]: 2.98, 95% CI: 1.23-7.23) and between rs739837 and hypertriglyceridemia (SI: 2.36, 95% CI: 1.05-5.31) on T2D susceptibility. Additionally, a significant linear association between fasting glucose and rs3847987 had been found at high triglyceride level (> 1.90 mmol/L) with an inversely concentration-dependent manner. The study provided further evidence that rs739837 and high level of triglyceride were both associated with higher T2D susceptibility in Chinese population. Additionally, the detrimental effect of VDR variants on T2D could be modified by hypertriglyceridemia status.

Progression to diabetes by baseline glycemic status among middle-aged and older adults in the United States, 2006-2014

AIMS

Primary prevention studies have indicated that structured lifestyle change programs in adults with an annual diabetes risk of 4.7% are cost-effective. However, few population-based studies have quantified the risk of diabetes among adults with prediabetes.

METHODS

We used the nationally representative U.S. Health and Retirement Study to identify adults aged ≥ 52 years with prediabetes (A1c: 5.7% - 6.4%) in 2006 and followed them to 2014 to assess diabetes status defined by A1c ≥ 6.5% in 2010 or 2014 or by self-report of a diabetes diagnosis by various risk factors.

RESULTS

Among the 1,406 adults with prediabetes (average 4.7 years of follow-up), risk factors significantly associated with subsequent incident diabetes with adjusted annual risk of diabetes ≥ 4.7% were: male gender (4.8%); aged 52-64 years (5.0%); Black race (5.5%); obesity (body mass index (kg/m²) ≥ 30.0, 6.8%); large waist circumference (women: > 35 in.; men: > 40 in., 4.9%); C-reactive protein levels ≥ 3 ug/L (5.5%); treated for high cholesterol (4.7%); treated for hypertension (5.3%); and moderate mobility loss (4.8%).

CONCLUSIONS

Primary prevention interventions among adults with prediabetes who also have moderate mobility loss or well-known risk factors for diabetes are likely to be cost-effective.

Phytotherapy for Cardiovascular Disease: A Bench-to-Bedside Approach

At present, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, and global trends suggest that this panorama will persist or worsen in the near future. Thus, optimization of treatment strategies and the introduction of novel therapeutic alternatives for CVD represent key objectives in contemporary biomedical research. In recent years, phytotherapy-defined as the therapeutic use of whole or minimally modified plant components-has ignited large scientific interest, with a resurgence of abundant investigation on a wide array of medicinal herbs (MH) for CVD and other conditions. Numerous MH have been observed to intervene in the pathophysiology of CVD via a myriad of molecular mechanisms, including antiinflammatory, anti-oxidant, and other beneficial properties, which translate into the amelioration of three essential aspects of the pathogenesis of CVD: Dyslipidemia, atherosclerosis, and hypertension. Although the preclinical data in this scenario is very rich, the true clinical impact of MH and their purported mechanisms of action is less clear, as large-scale robust research in this regard is in relatively early stages and faces important methodological challenges. This review offers a comprehensive look at the most prominent preclinical and clinical evidence currently available concerning the use of MH in the treatment of CVD from a bench-to-bedside approach.

Increased particle size of triacylglycerol-enriched remnant lipoproteins, but not their plasma concentration or lipid content, augments risk prediction of incident type 2 diabetes

AIMS/HYPOTHESIS

Type 2 diabetes prevention requires the accurate identification of those at high risk. Beyond the association of fasting serum triacylglycerols with diabetes, triacylglycerol-enriched remnant lipoproteins (TRLs) more accurately reflect pathophysiological changes that underlie progression to diabetes, such as hepatic insulin resistance, pancreatic steatosis and systemic inflammation. We hypothesised that TRL-related factors could improve risk prediction for incident diabetes.

METHODS

We included individuals from the Brazilian Longitudinal Study of Adult Health cohort. We trained a logistic regression model for the risk of incident diabetes in 80% of the cohort using tenfold cross-validation, and tested the model in the remaining 20% of the cohort (test set). Variables included medical history and traits of the metabolic syndrome, followed by TRL-related measurements (plasma concentration, TRL particle diameter, cholesterol and triacylglycerol content). TRL features were measured using NMR spectroscopy. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC).

RESULTS

Among 4463 at-risk individuals, there were 366 new cases of diabetes after a mean (±SD) of 3.7 (±0.63) years of follow-up. We derived an 18-variable model with a global AUROC of 0.846 (95% CI: 0.829, 0.869). Overall TRL-related markers were not associated with diabetes. However, TRL particle diameter increased the AUROC, particularly in individuals with HbA_1c <39 mmol/mol (5.7%) (hold-out test set [n = 659]; training-validation set [n = 2638]), but not in individuals with baseline HbA_1c 39-46 mmol/mol (5.7-6.4%) (hold-out test set [n = 233]; training-validation set [n = 933]). In the subgroup with baseline HbA_1c <39 mmol/mol (5.7%), AUROC in the test set increased from 0.717 (95% CI 0.603, 0.818) to 0.794 (95% CI 0.731, 0.862), and AUPRC in the test set rose from 0.582 to 0.701 when using the baseline model and the baseline model plus TRL particle diameter, respectively. TRL particle diameter was highly correlated with obesity, insulin resistance and inflammation in those with impaired fasting glucose at baseline, but less so in those with HbA_1c <39 mmol/mol (5.7%).

CONCLUSIONS/INTERPRETATION

TRL particle diameter improves the prediction of diabetes, but only in individuals with HbA_1c <39 mmol/mol (5.7%) at baseline. These data support TRL particle diameter as a risk factor that is changed early in the course of the pathophysiological processes that lead to the development of type 2 diabetes, even before glucose abnormalities are established. Graphical abstract.

Gender differences of relationship between serum lipid indices and type 2 diabetes mellitus: a cross-sectional survey in Chinese elderly adults

Background

To investigate the gender differences of the relationships between clinical serum lipid indices and type 2 diabetes mellitus (T2DM) in Chinese elderly adults.

Methods

Between 2014 and 2016, participants selected from three communities in an urban district of Shanghai were measured for serum lipid indices of low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), total cholesterol (TC), and triglyceride (TG). Age and multivariate adjusted logistic regression models were utilized to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of serum lipid indices on T2DM prevalence.

Results

In total, 4,023 male and 3,862 female participants were included in this study, with the T2DM prevalence proportions of 13.03% and 11.73%, respectively. In association analysis, the serum levels of LDL-c, HDL-c, TC were significant between non-T2DM individuals and T2DM patients in men, but the HDL-c and TG in women. LDL-c/HDL-c, TG/HDL-c, and TC/HDL-c ratios were associated with the T2DM prevalence only in women. In the multivariate analysis, a higher serum LDL-c level was positively associated with a reduced risk of T2DM prevalence in men with OR (95% CI) of 0.57 (0.39–0.85) (P=0.006). Higher ratios of LDL-c/HDL-c, TG/HDL-c, and TC/HDL-c were all more likely associated with the decreased risks of T2DM prevalence with the ORs ranging from 0.45 to 0.62 in men (all P<0.05), but not in women.

Conclusions

High LDL-c concentration was significantly associated with a lower T2DM prevalence in men. A gender difference of the associations between the lipid ratios and T2DM prevalence was observed for LDL-c/HDL-c and TC/HDL-c ratios, which might be validated in female T2DM prevalence in the future.

Effects of fenofibrate and its combination with lovastatin on the expression of genes involved in skeletal muscle atrophy, including FoxO1 and its targets

Fibrates and statins have been widely used to reduce triglyceride and cholesterol levels, respectively. Besides its lipid-lowering effect, the side effect of muscle atrophy after fibrate administration to humans has been demonstrated in some studies. Combination therapy with fibrates and statins also increases the risk of rhabdomyolysis. FoxO1, a member of the FoxO forkhead type transcription factor family, is markedly upregulated in skeletal muscle in energy-deprived states and induces muscle atrophy via the expression of E3-ubiquitine ligases. In this study, we investigated the changes in FoxO1 and its targets in murine skeletal muscle with fenofibrate treatment. High doses of fenofibrate (greater than 0.5% (wt/wt)) over one week increased the expression of FoxO1 and its targets in the skeletal muscles of mice and decreased skeletal muscle weight. These fenofibrate-induced changes were diminished in the PPARα knockout mice. When the effect of combination treatment with fenofibrate and lovastatin was investigated, a significant increase in FoxO1 protein levels was observed despite the lack of deterioration of muscle atrophy. Collectively, our findings suggest that a high dose of fenofibrate over one week causes skeletal muscle atrophy via enhancement of FoxO1, and combination treatment with fenofibrate and lovastatin may further increase FoxO1 protein level.

Mutation in the distal NPxY motif of LRP1 alleviates dietary cholesterol-induced dyslipidemia and tissue inflammation

The impairment of LDL receptor-related protein-1 (LRP1) in numerous cell types is associated with obesity, diabetes, and fatty liver disease. Here, we compared the metabolic phenotype of C57BL/6J wild-type and LRP1 knock-in mice carrying an inactivating mutation in the distal NPxY motif after feeding a low-fat diet or high-fat (HF) diet with cholesterol supplementation (HFHC) or HF diet without cholesterol supplementation. In response to HF feeding, both groups developed hyperglycemia, hyperinsulinemia, hyperlipidemia, increased adiposity, and adipose tissue inflammation and liver steatosis. However, LRP1 NPxY mutation prevents HFHC diet-induced hypercholesterolemia, reduces adipose tissue and brain inflammation, and limits liver progression to steatohepatitis. Nevertheless, this mutation does not protect against HFHC diet-induced insulin resistance. The selective metabolic improvement observed in HFHC diet-fed LRP1 NPxY mutant mice is due to an apparent increase of hepatic LDL receptor levels, leading to an elevated rate of plasma lipoprotein clearance and lower hepatic cholesterol levels. The unique metabolic phenotypes displayed by LRP1 NPxY mutant mice indicate an LRP1-cholesterol axis in modulating tissue inflammation. The LRP1 NPxY mutant mouse phenotype differs from phenotypes observed in mice with tissue-specific LRP1 inactivation, thus highlighting the importance of an integrative approach to evaluate how global LRP1 dysfunction contributes to metabolic disease development.

Risk of pre-eclampsia in patients with a maternal genetic predisposition to common medical conditions: a case-control study

OBJECTIVE

To assess whether women with a genetic predisposition to medical conditions known to increase pre-eclampsia risk have an increased risk of pre-eclampsia in pregnancy.

DESIGN

Case-control study.

SETTING AND POPULATION

Pre-eclampsia cases (n = 498) and controls (n = 1864) in women of European ancestry from five US sites genotyped on a cardiovascular gene-centric array.

METHODS

Significant single-nucleotide polymorphisms (SNPs) from 21 traits in seven disease categories (cardiovascular, inflammatory/autoimmune, insulin resistance, liver, obesity, renal and thrombophilia) with published genome-wide association studies (GWAS) were used to create a genetic instrument for each trait. Multivariable logistic regression was used to test the association of each continuous scaled genetic instrument with pre-eclampsia. Odds of pre-eclampsia were compared across quartiles of the genetic instrument and evaluated for significance.

MAIN OUTCOME MEASURES

Genetic predisposition to medical conditions and relationship with pre-eclampsia.

RESULTS

An increasing burden of risk alleles for elevated diastolic blood pressure (DBP) and increased body mass index (BMI) were associated with an increased risk of pre-eclampsia (DBP, overall OR 1.11, 95% CI 1.01-1.21, P = 0.025; BMI, OR 1.10, 95% CI 1.00-1.20, P = 0.042), whereas alleles associated with elevated alkaline phosphatase (ALP) were protective (OR 0.89, 95% CI 0.82-0.97, P = 0.008), driven primarily by pleiotropic effects of variants in the FADS gene region. The effect of DBP genetic loci was even greater in early-onset pre-eclampsia cases (at <34 weeks of gestation, OR 1.30, 95% CI 1.08-1.56, P = 0.005). For other traits, there was no evidence of an association.

CONCLUSIONS

These results suggest that the underlying genetic architecture of pre-eclampsia may be shared with other disorders, specifically hypertension and obesity.

TWEETABLE ABSTRACT

A genetic predisposition to increased diastolic blood pressure and obesity increases the risk of pre-eclampsia.

Relationship between Lipid Profiles and Glycemic Control Among Patients with Type 2 Diabetes in Qingdao, China

Glycosylated hemoglobin (HbA1c) was the best indicator of glycemic control, which did not show the dynamic relationship between glycemic control and lipid profiles. In order to guide the health management of Type 2 diabetes (T2D), we assessed the levels of lipid profiles and fasting plasma glucose (FPG) and displayed the relationship between FPG control and lipid profiles. We conducted a cross-sectional study that included 5822 participants. Descriptive statistics were conducted according to gender and glycemic status respectively. Comparisons for the control of lipid profiles were conducted according to glycemic control. Four logistic regression models were generated to analyze the relationship between lipid profiles and glycemic control according to different confounding factors. The metabolic control percentage of FPG, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) was 27.50%, 73.10%, 28.10%, 64.20% and 44.80% respectively. In the fourth model with the most confounding factors, the odds ratios (ORs) and 95% confidence intervals (CIs) of TG, TC, LDL-C and HDL-C were 0.989 (0.935, 1.046), 0.862 (0.823, 0.903), 0.987 (0.920, 1.060) and 2.173 (1.761, 2.683). TC and HDL-C were statistically significant, and TG and LDL-C were not statistically significant with adjustment for different confounding factors. In conclusion, FPG was significantly associated with HDL and TC and was not associated with LDL and TG. Our findings suggested that TC and HDL should be focused on in the process of T2D health management.

Anti‑glycolipid disorder effect of epigallocatechin‑3‑gallate on high‑fat diet and STZ‑induced T2DM in mice

Epigallocatechin-3-gallate (EGCG) is beneficial for inhibiting dyslipidemia and reducing hyperlipidemic risk. The purpose of the present study was to investigate the glycolipid regulatory effects and potential mechanisms of EGCG in a high-fat diet and streptozotocin-induced type 2 diabetes mellitus (T2DM) mouse model. The results demonstrated that EGCG can decrease blood glucose levels and increase insulin resistance in T2DM mice. In addition, EGCG can regulate serum lipid levels, including those of total cholesterol, triglyceride and low-density lipoprotein receptor (LDL-r), and reduce lipid deposition in vascular endothelial cells in a dose-dependent manner. In addition, the gene and protein expression of related scavenger receptors, including cluster of differentiation 36, sterol regulatory element binding protein 2 (SREBP), SREBP cleavage-activating protein and LDL-r, were downregulated in a dose-dependent manner. The present study noted that EGCG possesses potential as a natural product for preventing and treating metabolic hyperlipidemia syndrome, probably by reducing the blood lipid levels, alleviating vascular endothelial cell damage, maintaining normal lipid metabolism in blood vessels and ameliorating glycolipid disorders.

Minority-centric meta-analyses of blood lipid levels identify novel loci in the Population Architecture using Genomics and Epidemiology (PAGE) study

Lipid levels are important markers for the development of cardio-metabolic diseases. Although hundreds of associated loci have been identified through genetic association studies, the contribution of genetic factors to variation in lipids is not fully understood, particularly in U.S. minority groups. We performed genome-wide association analyses for four lipid traits in over 45,000 ancestrally diverse participants from the Population Architecture using Genomics and Epidemiology (PAGE) Study, followed by a meta-analysis with several European ancestry studies. We identified nine novel lipid loci, five of which showed evidence of replication in independent studies. Furthermore, we discovered one novel gene in a PrediXcan analysis, minority-specific independent signals at eight previously reported loci, and potential functional variants at two known loci through fine-mapping. Systematic examination of known lipid loci revealed smaller effect estimates in African American and Hispanic ancestry populations than those in Europeans, and better performance of polygenic risk scores based on minority-specific effect estimates. Our findings provide new insight into the genetic architecture of lipid traits and highlight the importance of conducting genetic studies in diverse populations in the era of precision medicine.

Dyslipidemia in diabetes: a population-based study in Bali

Purpose

To establish the lipid pattern in subjects with diabetes mellitus (DM) and factors that are correlated with insulin resistance and lipid disorders in a population of Bali.

Methods

A cross-sectional population-based study which enrolled 1840 subjects (age 13–100 years) from 7 villages was carried out. Several clinical parameters were measured including age, gender, body mass index, waist circumference (WC), fasting blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) A (apoA), apoB, non-HDL-C, T/HDL-C ratio, LDL-C/apoB ratio, apoB/A ratio, plasma insulin, and homeostasis of model assessment-insulin resistance (HOMA-IR).

Results

TC, TG, and non-HDL-C levels were higher in DM subjects than in normal glucose tolerance (NGT) subjects in both genders; total/HDL-C ratio was higher in subjects with DM than in NGT subjects only in men; LDL-C levels, apoB levels, and apoB/A ratios were higher and LDL/apoB was lower in subjects with DM than in NGT in women. In subjects with DM, the target for LDL-C (79%), non-HDL-C (85.2%), apoB (80%), HDL-C (34.9%), TG (46.7%), and small-dense low density lipoprotein (42.2%) was not achieved.

Conclusion

FBG was correlated with TC, TG, LDL-C, apoB, non-HDL-C levels, LDL/apoB, and apoB/apoA ratios. Subjects with DM had higher levels of TC, TG, and non-HDL-C levels in both genders; T/HDL-C ratio only in men; LDL-C, apoB/apoA ratio and lower LDL/apoB ratio only in women. Obesity was correlated with lipid levels. WC was correlated with LDL/apoB ratio, insulin level, HOMA-IR, and TG; highest absolute strength of correlation was with LDL/apoB ratio. Insulin resistance was correlated with lipid levels or ratios, especially in women. In women, HOMA-IR had a positive correlation with total/HDL-C ratio, non-HDL-C, apoB, and a negative correlation with HDL-C levels.

Circulating lipids, mammographic density, and risk of breast cancer in the Nurses' Health Study and Nurses' Health Study II

PURPOSE

Epidemiologic evidence supports an association between high mammographic density and increased breast cancer risk yet etiologic mechanisms remain largely unknown. Mixed evidence exists as to whether circulating lipid levels influence mammographic density and breast cancer risk. Therefore, we examined these associations in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHSII), two large prospective cohorts with information on PMD and circulating lipid measures, long follow-up, and breast cancer risk factor and outcome data.

METHODS

We conducted a nested case-control study among women in the NHS and NHSII. Percent mammographic density (PMD) was measured using Cumulus software, a computer-assisted method, on digitized film mammograms. Cross-sectional associations between circulating lipids [total cholesterol (n = 1,502), high-density lipoprotein (HDL-C; n = 579), and triglycerides (n = 655)] and PMD were evaluated among controls. All analyses were stratified by menopausal status at time of mammogram. Relative risks for breast cancer by lipid and PMD measures were estimated among postmenopausal women in the full nested case-control study (cases/controls for cholesterol, HDL-C, and triglycerides were 937/975, 416/449, and 506/537, respectively).

RESULTS

There were no significant associations between circulating lipid levels and PMD among healthy women, irrespective of menopausal status. The association between PMD and breast cancer risk among postmenopausal women was not modified by circulating lipid levels (p interaction = 0.83, 0.80, and 0.34 for total cholesterol, HDL-C, and triglycerides, respectively).

CONCLUSION

Overall, no association was observed between lipid levels and PMD, and there was no evidence that lipid levels modified the association between PMD and breast cancer risk.

TRIB1 and TRPS1 variants, G × G and G × E interactions on serum lipid levels, the risk of coronary heart disease and ischemic stroke

This study aimed to assess the association of the tribbles pseudokinase 1 (TRIB1) and transcriptional repressor GATA binding 1 (TRPS1) single nucleotide polymorphisms (SNPs) and the gene-gene (G × G) and gene-environment (G × E) interactions with serum lipid levels, the risk of coronary heart disease (CHD) and ischemic stroke (IS) in the Guangxi Han population. Genotyping of the rs2954029, rs2980880, rs10808546, rs231150, rs2737229 and rs10505248 SNPs was performed in 625 controls and 1146 unrelated patients (CHD, 593 and IS, 553). The genotypic and allelic frequencies of some SNPs were different between controls and patients (CHD, rs2954029 and rs231150; IS, rs2954029 and rs2980880; P < 0.05-0.01). Two SNPs were associated with increased risk of CHD (rs2954029 and rs231150) and IS (rs2954029) in different genetic models. Several SNPs in controls were associated with total cholesterol (rs2954029, rs2980880 and rs2737229), triglyceride (rs2954029 and rs10808546), low-density lipoprotein cholesterol (rs2954029), high-density lipoprotein cholesterol (rs2980880 and rs231150) and apolipoprotein A1 (rs2737229) levels. The rs2954029TA/AA-age (>60 year) interaction increased the risk of CHD, whereas the rs10808546CT/TT-drinking interaction decreased the risk of IS. The rs2954029A-rs2980880C-rs10808546C haplotype was associated with increased risk of CHD and IS. The rs2954029A-rs2980880T-rs10808546C haplotype was associated with increased risk of CHD. The rs2954029-rs231150 interactions had an increased risk of both CHD and IS. These results suggest that several TRIB1 and TRPS1 SNPs were associated with dyslipidemia and increased risk of CHD and IS in our study population. The G × G and G × E interactions on serum lipid levels, and the risk of CHD and IS were also observed.

The Role of High-Density Lipoproteins in Diabetes and Its Vascular Complications

Almost 600 million people are predicted to have diabetes mellitus (DM) by 2035. Diabetic patients suffer from increased rates of microvascular and macrovascular complications, associated with dyslipidaemia, impaired angiogenic responses to ischaemia, accelerated atherosclerosis, and inflammation. Despite recent treatment advances, many diabetic patients remain refractory to current approaches, highlighting the need for alternative agents. There is emerging evidence that high-density lipoproteins (HDL) are able to rescue diabetes-related vascular complications through diverse mechanisms. Such protective functions of HDL, however, can be rendered dysfunctional within the pathological milieu of DM, triggering the development of vascular complications. HDL-modifying therapies remain controversial as many have had limited benefits on cardiovascular risk, although more recent trials are showing promise. This review will discuss the latest data from epidemiological, clinical, and pre-clinical studies demonstrating various roles for HDL in diabetes and its vascular complications that have the potential to facilitate its successful translation.

Unexplained reciprocal regulation of diabetes and lipoproteins

PURPOSE OF REVIEW

Type 2 diabetes is associated with a characteristic dyslipidemia that may exacerbate cardiovascular risk. The causes of, and the effects of new antihyperglycemia medications on, this dyslipidemia, are under investigation. In an unexpected reciprocal manner, lowering LDL-cholesterol with statins slightly increases the risk of diabetes. Here we review the latest findings.

RECENT FINDINGS

The inverse relationship between LDL-cholesterol and diabetes has now been confirmed by multiple lines of evidence. This includes clinical trials, genetic instruments using aggregate single nucleotide polymorphisms, as well as at least eight individual genes - HMGCR, NPC1L1, HNF4A, GCKR, APOE, PCKS9, TM6SF2, and PNPLA3 - support this inverse association. Genetic and pharmacologic evidence suggest that HDL-cholesterol may also be inversely associated with diabetes risk. Regarding the effects of diabetes on lipoproteins, new evidence suggests that insulin resistance but not diabetes per se may explain impaired secretion and clearance of VLDL-triglycerides. Weight loss, bariatric surgery, and incretin-based therapies all lower triglycerides, whereas SGLT2 inhibitors may slightly increase HDL-cholesterol and LDL-cholesterol.

SUMMARY

Diabetes and lipoproteins are highly interregulated. Further research is expected to uncover new mechanisms governing the metabolism of glucose, fat, and cholesterol. This topic has important implications for treating type 2 diabetes and cardiovascular disease.

Prioritising Risk Factors for Type 2 Diabetes: Causal Inference through Genetic Approaches

PURPOSE OF THE REVIEW

Causality has been demonstrated for few of the many putative risk factors for type 2 diabetes (T2D) emerging from observational epidemiology. Genetic approaches are increasingly being used to infer causality, and in this review, we discuss how genetic discoveries have shaped our understanding of the causal role of factors associated with T2D.

RECENT FINDINGS

Genetic discoveries have led to the identification of novel potential aetiological factors of T2D, including the protective role of peripheral fat storage capacity and specific metabolic pathways, such as the branched-chain amino acid breakdown. Consideration of specific genetic mechanisms contributing to overall lipid levels has suggested that distinct physiological processes influencing lipid levels may influence diabetes risk differentially. Genetic approaches have also been used to investigate the role of T2D and related metabolic traits as causal risk factors for other disease outcomes, such as cancer, but comprehensive studies are lacking. Genome-wide association studies of T2D and metabolic traits coupled with high-throughput molecular phenotyping and in-depth characterisation and follow-up of individual loci have provided better understanding of aetiological factors contributing to T2D.

CD36 gene variants is associated with type 2 diabetes mellitus through the interaction of obesity in rural Chinese adults

BACKGROUND

Evidences show that cluster determinant 36 (CD36) protein plays a role in lipid metabolism and insulin resistance, and the expression of CD36 is inducible in obesity. The present study evaluated the association of CD36 variants and the interaction with obesity on type 2 diabetes mellitus (T2DM) risk.

METHODS

We performed a case-control study nested in the Rural Chinese Cohort Study. We included 546 incident T2DM cases matched with non-T2DM controls in a 1:1 ratio by sex, age (within 2 years), marital status, and residence village. Four loci in CD36 (rs1194197, rs2151916, rs3211956, and rs7755) were genotyped by SNPscan^TM Genotyping system.

RESULTS

After adjusting for potential confounding, we observed no statistically significant association between the CD36 polymorphisms and T2DM risk. Compared to wild-type homozygous carriers with normal weight, overweight/obesity participants carrying the mutational allele rs7755 showed increased risk of T2DM, by 114% (OR = 2.14, 95% CI: 1.33-3.46; P_interaction = 0.007); abdominal obesity participants carrying the mutational allele rs7755 showed increased risk of T2DM, by 133% (OR = 2.33, 95% CI: 1.48-3.66; P_interaction = 0.002). Furthermore, rs2151916 polymorphism was associated with triglycerides level (P = 0.019), and the rs1194197 variant was related to systolic blood pressure (P = 0.023) within the group of controls.

CONCLUSIONS

CD36 genotypes were not associated with the progression to T2DM independently. However, our results suggested a positive interaction between the CD36 variants and obesity on T2DM susceptibility, which might be through a cardiometabolic disorder.

Association between the GPAM rs1129555 SNP and serum lipid profiles in the Maonan and Han populations

The glycerol-3-phosphate acyltransferase mitochondrial gene (GPAM) variant has been associated with serum lipid levels in the Eurpean ancestry, but little is known about such association in Chinese populations. The aim of the present study was to investigate the relationship between the GPAM rs1129555 single nucleotide polymorphism (SNP) and several environment factors with blood lipid profiles in the Guangxi Maonan and Han populations. A total of 720 individuals of Maonan nationality and 780 participants of Han nationality were randomly selected from our previous stratified randomized samples. Genotyping of the rs1129555 SNP was carried out using the polymerase chain reaction-restriction fragment length polymorphism technique, and then confirmed by direct sequencing. The frequencies of C and T alleles were 72.85% and 27.15% in Maonan, and 65.19% and 34.81% in Han (P < 0.001); respectively. The frequencies of CC, CT, and TT genotypes were 51.53%, 42.36%, and 5.97% in Maonan, and 43.08%, 44.23%, and 12.69% in Han populations (P < 0.001). The T allele carriers had higher serum triglyceride (TG) in Han and higher low-density lipoprotein cholesterol (LDL-C) in both Maonan and Han than the T allele non-carriers (P < 0.05-0.01). Gender subgroup analyses showed that the T allele carriers had higher TG levels in Han males (P < 0.05) and higher LDL-C levels in Maonan males but not in famales (P < 0.01). Serum lipid parameters were also associated with several environmental factors (P < 0.05-0.001). These findings suggest that racial/ethnic- and/or gender-specific association occurs between the GPAM rs1129555 variant and serum lipid parameters in our study populations.

Risk of type 2 diabetes mellitus associated with plasma lipid levels: The rural Chinese cohort study

AIM

To investigate the association of type 2 diabetes mellitus (T2DM) risk and plasma lipid levels in rural Chinese.

METHODS

Each lipid variable was divided into quartiles and dichotomized by clinical cutoff points. Cox proportional-hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of T2DM risk and plasma lipid levels and explore the interaction between plasma lipid levels and other risk factors.

RESULTS

11,929 participants were included in the analysis. We documented 720 incident cases of T2DM over 70,720.84 person-years of follow-up, for an incidence of 10.18/1,000 person-years. In the multivariable-adjusted model, risk of T2DM was increased with the highest versus lowest quartiles of total cholesterol (TC) and triglycerides (TG) levels and TC/high-density lipoprotein-cholesterol (HDL-C) and TG/HDL-C ratios. The HRs (95% CIs) for the fourth quartiles, for example, were 1.34 (1.03-1.74), 2.32 (1.73-3.13), 1.66 (1.23-2.25), and 1.84 (1.38-2.45), respectively. In addition, risk of T2DM was increased with high TG level and TC/HDL-C and TG/HDL-C ratios by clinical cutoffs. The HRs (95% CIs) were 1.50 (1.25-1.80), 1.24 (1.03-1.48), and 1.44 (1.18-1.75), respectively. Risk of T2DM was associated with interactions between all lipid variables and age and BMI. TG level and TG/HDL-C ratio additionally interacted with gender (all P_interaction < 0.0001).

CONCLUSIONS

Risk of T2DM was increased with elevated serum levels of TC and TG and TC/HDL-C and TG/HDL-C ratios and also with interactions between high TC and TG levels and TC/HDL-C and TG/HDL-C ratios and age and BMI in a rural Chinese population.

Association between unfavorable lipid profile and glycemic control in patients with type 2 diabetes mellitus

Background:

Recent studies hypothesize that dyslipidemia can predict glycated hemoglobin (HbA1c) and could be important contributing factor to the pathogenesis of type 2 diabetes mellitus (DM2). Therefore, we aimed to evaluate the influence of lipid parameters on long-term glycemic control in DM2.

Materials and Methods:

A total of 275 sedentary DM2 (mean [±standard deviation] age 60.6 [±10.0] years) who volunteered to participate in this cross-sectional study were enrolled. Anthropometric (body weight, body hight, and waist circumference), biochemical parameters (fasting glucose, HbA1c, lipid parameters, creatinine), as well as blood pressure were obtained.

Results:

Total cholesterol (odds ratio [OR] =1.30, 95% confidence interval [CI] [1.02–1.66], P = 0.032), triglycerides (OR = 1.34, 95% CI (1.07–1.67), P = 0.010), and low density lipoprotein cholesterol (OR = 1.42, 95% CI [1.10–1.83], P = 0.006) were the independent predictors of higher HBA1c, and as they increased by 1 mmol/L each, probabilities of higher HBA1c increased by 30%, 34%, and 42%, respectively. Low level of high-density lipoprotein cholesterol (HDL-c) was found to be the independent predictor of higher HBA1c (OR = 0.44, 95% CI [0.20–0.67], P = 0.039), and increase in HDL-c by 1 mmol/L, reduced the probability of higher HBA1c by 56%.

Conclusion:

Unfavorable lipid profile can predict HbA1c level in DM2 patients. Early diagnosis of dyslipidemia, as well as its monitoring and maintaining good lipids control can be used as a preventive measure for optimal long-term glycemic control.

Prediabetes and cardiovascular complications screening in Nigeria: A family case presentation

Metabolic disorders are on the increase globally, and the need for screening remains imperative. This case report is of a 48-year-old man who was screened as dyslipidaemic and on metabolic syndrome prevention, precipitating screening of family relatives. The extended family members (N=11) were invited for screening, of which 4 were hyperglycaemic, 3 had hypercholesterolaemia; and the HDL levels of 6 participants were abnormal. All family members had normal plasma triglyceride levels, and 4 people had high blood pressure. There was an indication that 55% members of a family had up to two metabolic disorders or risk factors including dyslipidaemia that may predispose them to CVD; as well as family history of periodontitis in the family. This pilot study plans to follow-up its association with dyslipidaemia as well as with prediabetes. The feasibility of using simple and affordable screening test for diabetes in oral health clinics and vice versa, including review of observations of technical importance relevant to pathology logistics will be investigated.

Association between the ratio of triglyceride to high-density lipoprotein cholesterol and incident type 2 diabetes in Singapore Chinese men and women

BACKGROUND

Increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) are risk factors for type 2 diabetes (T2D). The relationship between TG:HDL-C ratio and T2D risk is not clear, and it is not known whether the association is modified by gender, body mass index, or fasting status. This study examined the relationship between TG:HDL-C ratio and risk of incident T2D, and the predictive ability of the ratio on top of other diabetes risk factors.

METHODS

Blood biomarkers were determined in 571 T2D cases and 571 controls nested within a prospective, population-based cohort study, the Singapore Chinese Health Study. Participants were free of diagnosed diabetes, cardiovascular disease, and cancer at the time of blood collection (1999-2004). Incident self-reported T2D cases were identified at follow-up interview (2006-10). Controls were matched 1:  1 for age, sex, dialect group, and date of blood collection. Multivariable logistic regression was used to compute the odds ratio (OR) and 95 % confidence interval (CI).

RESULTS

The ORs (95 % CI) of T2D per 1-SD increment in TG and TG:  HDL-C ratio were 1.70 (1.39-2.09) and 1.72 (1.37-2.17), respectively. The relationships were stronger among females than males (P_interaction  = 0.028 and 0.017, respectively), and stronger among lean (<23 kg/m² ) than overweight/obese participants (P_interaction  = 0.051 and 0.046, respectively). Both TG and TG:  HDL-C improved T2D prediction to a similar degree.

CONCLUSIONS

Both TG and TG:HDL-C ratio are independent risk factors for incident T2D, and confer greater risk in women and lean participants. The TG:  HDL-C ratio is not a better predictor of diabetes than TG alone.

Are visceral adiposity index and lipid accumulation product reliable indices for metabolic disturbances in patients with type 2 diabetes mellitus?

BACKGROUND

Visceral adiposity index (VAI) and Lipid accumulation product (LAP) are novel visceral adiposity indexes, proposed for the evaluation of cardiometabolic risk in adult population. Considering contradictory results obtained from many studies so far, we aimed to examine the potential benefit of applicability of VAI and LAP, over simple anthropometric indices and traditional lipid parameters in individuals with type 2 diabetes mellitus (DM2).

METHODS

A total of 180 DM2 (of them 50% females) and 119 controls who volunteered to participate in this cross-sectional study were enrolled. Anthropometric and biochemical parameters, as well as blood pressure were obtained. VAI and LAP were calculated.

RESULTS

Multivariate logistic regression analysis showed that high-density lipoprotein cholesterol (HDL-c), (P<.001), waist circumference (WC), (P=.027), age (P=.001), hypolipemic therapy (P=.024), and LAP (P=.005) were independent predictors of DM2 in adjusted models. In Receiver Operating Characteristic curve analysis, used to discriminate subjects with DM2 from those who did not have it, good accuracy of the applied procedures was only achieved with models which were consisted of parameters used in VAI (Body mass index, WC, HDL-c, triglycerides) and LAP (WC, triglycerides) indexes equations, respectively [Area under the curve (AUC)=0.819 and AUC=0.800, respectively], but not with VAI (AUC=0.781) and LAP (AUC=0.784) indexes themselves.

CONCLUSION

Visceral adiposity index and Lipid accumulation product may not be better than parameters that enter its equation in type 2 diabetes prediction.

Development and evaluation of a risk score for type 2 diabetes mellitus among middle-aged Chinese rural population based on the RuralDiab Study

The purpose of this study was to establish a simple and effective risk score for type 2 diabetes mellitus (T2DM) in middle-aged rural Chinese. Total of 5453 participants aged 30–59 years from the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study were recruited for establishing the RuralDiab risk score by using logistic regression analysis. The RuralDiab risk score was validated in a prospective study from Henan Province of China, and compared with previous risk scores by using the receiver-operating characteristics cure. Ultimately, sex, age, family history of diabetes, physical activity, waist circumference, history of dyslipidemia, diastolic blood pressure, body mass index were included in the RuralDiab risk score (range from 0 to 36), and the optimal cutoff value was 17 with 67.9% sensitivity and 67.8% specificity. The area under the cures (AUC) of the RuralDiab risk score was 0.723(95%CI: 0.710–0.735) for T2DM in validation population, which was significant higher than the American Diabetes Association score (AUC: 0.636), the Inter99 score (AUC: 0.669), the Oman risk score (AUC: 0.675). The RuralDiab risk score was established and demonstrated an appropriate performance for predicting T2DM in middle-aged Chinese rural population. Further studies for validation should be implemented in different populations.

Fenofibrate/simvastatin fixed-dose combination in the treatment of mixed dyslipidemia: safety, efficacy, and place in therapy

Lipids disorder is the principal cause of atherosclerosis and may present with several forms, according to blood lipoprotein prevalence. One of the most common forms is combined dyslipidemia, characterized by high levels of triglycerides and low level of high-density lipoprotein. Single lipid-lowering drugs may have very selective effect on lipoproteins; hence, the need to use multiple therapy against dyslipidemia. However, the risk of toxicity is a concerning issue. In this review, the effect and safety of an approved combination therapy with simvastatin plus fenofibrate are described, with an analysis of pros and cons resulting from randomized multicenter trials, meta-analyses, animal models, and case reports as well.

Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus

Background and Objective:

Hyperlipidemia and dyslipidemia are very common conditions among patients with Type-2 diabetes mellitus (T2DM) and associated with increased risk of coronary heart diseases. Physical activity and exercises along with medical management and dietary plan are common strategies to use for the management of deranged lipid profile in patients with T2DM. We aimed to determine the effects of supervised structured aerobic exercise training (SSAET) program on high and low density lipoprotein in patients with T2DM.

Methods:

This randomized control trial study was conducted at Riphah Rehabilitation Research Centre (RRRC), Pakistan Railway General Hospital (PRGH) Rawalpindi from 1^st January 2015 to 30^th March 2016. The inclusion criteria was Type-2 diabetes patients of both gender aged between 40 to 70 years. Patients with severe complications like coronary artery diseases (CAD), and other serious complications like diabetic foot, and severe knee and hip osteoarthritis (OA) were excluded from the study. A total of 195 patients diagnosed with T2DM were screened out and 102 were selected for the study as per the inclusion criteria. All participants were randomly assigned into two groups, experimental ‘A’ (n=51) and control ‘B’ (n=51). Patients in group A were treated with SSAET program of 25 weeks at 3 days a week in addition to routine medical management, while patients in Group-B were on their routine medications and dietary plan. Serum LDL, and HDL were tested at baseline and after 25 weeks. The data was analysed through SPSS 20.

Results:

Mean and standard deviation of LDL in group A (n=51) was 118.56±19.17 (pre) and 102.64±13.33 (post), while the mean and standard deviation for Group-B (n=51) was 116.50±18.45 (Pre) and 109.88±17.13 (post). Both groups showed improvement but, Group-A treated with SSAET along with RMM showed significantly higher (P Value ≤ 0.05) improvement as compared with group B treated with RMM alone. Mean and standard deviation of HDL in Group-A was 42.70±8.06 (pre) and 47.47±7.16 (post), while the mean and standard deviation of group B is 43.37±8.15 (Pre) and 44.41±7.91 (post). Both groups showed improvement but Group-A treated with SSAET program along with RMM showed significantly higher (P Value ≤ 0.05) improvement than group B treated with RMM alone.

Conclusion:

SSAET program along with RMM is more effective strategy for the management of deranged lipid profile in patients with T2DM.

Genetic predisposition to elevated levels of C-reactive protein is associated with a decreased risk for preeclampsia

OBJECTIVE

To examine the association between genetic predisposition to elevated C-reactive protein (CRP)and risk for preeclampsia using validated genetic loci for C-reactive protein.

METHODS

Preeclampsia cases (n = 177) and normotensive controls (n = 116) were selected from live birth certificates to nulliparous Iowa women during the period August 2002-May 2005. Disease status was verified by the medical chart review. Genetic predisposition to CRP was estimated by a genetic risk score on the basis of established loci for CRP levels. Logistic regression analyses were used to evaluate the relationships between the genotype score and preeclampsia. Replication analyses were performed in an independent, US population of preeclampsia cases (n = 516) and controls (n = 1,097) of European ancestry.

RESULTS

The genetic risk score (GRS) related to higher levels of CRP demonstrated a significantly decreased risk of preeclampsia (OR 0.89, 95% CI 0.82-0.96). When the GRS was analyzed by quartile, an inverse linear trend was observed (p = 0.0006). The results were similar after adjustments for the body mass index (BMI), smoking, and leisure-time physical activity. In the independent replication population, the association with the CRP GRS was also marginally significant (OR 0.97, 95% CI 0.92, 1.02). Meta-analysis of the two studies was statistically significant (OR 0.95, 95% CI 0.90, 0.99).

CONCLUSION

Our data suggest an inverse, counterintuitive association between the genetic predisposition to elevated levels of CRP and a decreased risk of preeclampsia. This suggests that the blood CRP level is a marker of preeclampsia, but it does not appear to be a factor on the causal pathway.

Dyslipidemia and associated factors among diabetic patients attending Durame General Hospital in Southern Nations, Nationalities, and People's Region

BACKGROUND

Diabetes mellitus is a group of metabolic disorders that are caused by deficiency in insulin secretion or the decreased ability of insulin to act effectively on target tissues, particularly muscle, liver, and fat. As a result of insulin resistance in the target tissues, particularly in the adipocytes, free fatty acid flux is increased, leading to increased lipid synthesis in hepatocytes, which is responsible for diabetic dyslipidemia.

OBJECTIVE

The objective of this study was to determine the prevalence and associated factors of dyslipidemia among diabetic patients in Durame General Hospital in Kembata Tembaro zone.

METHODS

A cross-sectional study was conducted from September 2015 to April 2016. In total, 224 subjects were involved in the study by using convenient sampling techniques. Face-to-face interview-administered questionnaire was used to collect sociodemographic data and other possible clinical data associated with the prevalence of dyslipidemia. Fasting venous blood specimens were collected to assess serum lipid profiles. Blood pressure (BP), weight, height, and waist circumference were measured.

RESULTS

The prevalence of dyslipidemia was 65.6%. Individual lipid abnormality of elevated LDL-C, TC, TG, and reduced HDL-C were identified in 43.8%, 23.7%, 40.6%, and 41.9% of study subjects, respectively. The prevalence of dyslipidemia was significantly associated with high BP, high body mass index, aging, and longer duration of diabetes mellitus.

CONCLUSION

High prevalence of dyslipidemia was found among diabetic patients in the study area. Therefore, a compressive mechanism is required to screen, treat, and prevent dyslipidemia.