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Cheng Y, Wang Z, Jia X, Zhou R, Wang J. Association Between Abdominal Adipose Tissue Distribution and Risk of Endometrial Cancer: A Case-Control Study. Clin Med Insights Oncol 2022; 16:11795549221140776. [PMCID: PMC9742701 DOI: 10.1177/11795549221140776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Obesity contributes to endometrial cancer (EC). However, it is not clear whether the distribution of adipose tissue affects the occurrence of endometrial carcinoma. This study aimed to evaluate the relationship between abdominal adipose tissue distribution and EC. Methods: We designed a case-control study with 115 women with EC and a control group. The total abdominal adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue were measured by single slice computerized tomography at the level of umbilicus. Univariate and multivariate logistic regression models were used to calculate odds ratios (ORs) for the risk of EC associated with adipose tissue distribution. Furthermore, we analyzed the correlation between adipose tissue distribution and clinicopathologic features of endometrial carcinoma. Results: Multivariate analysis showed that a larger visceral adipose tissue ratio was associated with an increased risk of EC after adjusting for body mass index (BMI) and diabetes (OR = 1.046, 95% confidence interval = [1.008-1.079]). The ratio of International Federation of Obstetrics and Gynecology (FIGO) stage I and type I EC was higher in EC patients with larger visceral adipose tissue (84.5% vs 63.2%, P = .009; 91.4% vs 75.4%, P = .021). There was a higher positive ratio of progesterone receptor in EC patients with a larger subcutaneous adipose tissue area (91.2% vs 77.6%; P = .044). Conclusions: Higher visceral adipose tissue ratio, independent of BMI, was associated with an increased risk of EC. Therefore, this study demonstrated that women with normal BMI, but abnormal abdominal adipose tissue distribution, have an increased risk for EC.
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Affiliation(s)
- Yuan Cheng
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China
| | - Zhongyu Wang
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China
| | - Xiaoxuan Jia
- Department of Radiology, Peking University People’s Hospital, Beijing, China
| | - Rong Zhou
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China
| | - Jianliu Wang
- Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing, China,Jianliu Wang, Department of Gynecology and Obstetrics, Peking University People’s Hospital, Beijing 100044, China.
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2
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Alser M, Elrayess MA. From an Apple to a Pear: Moving Fat around for Reversing Insulin Resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114251. [PMID: 36361131 PMCID: PMC9659102 DOI: 10.3390/ijerph192114251] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 06/02/2023]
Abstract
Type 2 diabetes (T2D) is a chronic condition where the body is resistant to insulin, leading to an elevated blood glucose state. Obesity is a main factor leading to T2D. Many clinical studies, however, have described a proportion of obese individuals who express a metabolically healthy profile, whereas some lean individuals could develop metabolic disorders. To study obesity as a risk factor, body fat distribution needs to be considered rather than crude body weight. Different individuals' bodies favor storing fat in different depots; some tend to accumulate more fat in the visceral depot, while others tend to store it in the femoral depot. This tendency relies on different factors, including genetic background and lifestyle. Consuming some types of medications can cause a shift in this tendency, leading to fat redistribution. Fat distribution plays an important role in the progression of risk of insulin resistance (IR). Apple-shaped individuals with enhanced abdominal obesity have a higher risk of IR compared to BMI-matched pear-shaped individuals, who store their fat in the gluteal-femoral depots. This is related to the different adipose tissue physiology between these two depots. In this review, we will summarize the recent evidence highlighting the underlying protective mechanisms in gluteal-femoral subcutaneous adipose tissues compared to those associated with abdominal adipose tissue, and we will revise the recent evidence showing antidiabetic drugs that impact fat distribution as they manage the T2D condition.
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Affiliation(s)
- Maha Alser
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar
| | - Mohamed A. Elrayess
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar
- College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
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3
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Lee-Ødegård S, Ueland T, Thorsby PM, Aukrust P, Michelsen AE, Halvorsen B, Drevon CA, Birkeland KI. Fetuin-A mediates the difference in adipose tissue insulin resistance between young adult pakistani and norwegian patients with type 2 diabetes. BMC Endocr Disord 2022; 22:208. [PMID: 35978354 PMCID: PMC9386965 DOI: 10.1186/s12902-022-01127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND South-Asian immigrants to Western countries have a high prevalence of type 2 diabetes mellitus (T2DM) and increased adipose tissue insulin resistance (AT-IR), as compared to their Western counterparts. Fetuin-A is a hepatokine known to influence AT-IR. AIM Can plasma fetuin-A concentrations explain an ethnic difference in adipose tissue insulin resistance? METHODS We performed a two-step euglycemic-hyperinsulinaemic clamp and measured plasma concentrations of fetuin-A and non-esterified fatty acids (NEFA), in 18 Pakistani and 21 Norwegians with T2DM (age 29-45y) in Norway. AT-IR was calculated as NEFA-suppression during the clamp. The adipokines/cytokines leptin, adiponectin, visfatin, PTX3, IL-1β, INF-γ, and IL-4 were measured in fasting plasma. Liver fat was estimated by CT-scans. RESULTS Despite a lower BMI, Pakistani patients displayed higher AT-IR than Norwegians. NEFA-suppression during clamp was lower in Pakistani than Norwegians (mean=-20.6%, 95%CI=[-40.8, -0.01] and p = 0.046). Plasma fetuin-A concentration was higher in Pakistani than Norwegians (43.4 ng/mL[12.7,74.0], p = 0.007) and correlated negatively to %NEFA-suppression during clamp (rho=-0.39, p = 0.039). Plasma fetuin-A concentration explained 22% of the ethnic difference in NEFA-suppression during the clamp. Pakistani patients exhibited higher plasma leptin and lower PTX3 levels than Norwegian, and plasma visfatin correlated positively to plasma fetuin-A levels in the Pakistani patients. We observed no correlation between plasma fetuin-A and liver fat, but fetuin-A correlated negatively with plasma IL-1β, INF-γ, and IL-4 concentrations. Plasma IL-4 concentration was lower in Pakistani than in Norwegian patients. CONCLUSION Fetuin-A may contribute to explain the discrepancy in T2DM prevalence between Pakistani and Norwegians patients by influencing AT-IR.
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Affiliation(s)
| | - Thor Ueland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Per M Thorsby
- Hormone Laboratory, Dep of Medical Biochemistry and Biochemical endocrinology and metabolism research group, Oslo University Hospital, Aker, Oslo, Norway
| | - Pål Aukrust
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Annika E Michelsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Bente Halvorsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kåre I Birkeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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4
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Alavi DH, Sakinis T, Henriksen HB, Beichmann B, Fløtten A, Blomhoff R, Lauritzen PM. Body composition assessment by artificial intelligence from routine computed tomography scans in colorectal cancer: Introducing BodySegAI. JCSM CLINICAL REPORTS 2022. [DOI: 10.1002/crt2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dena Helene Alavi
- Department of Nutrition, Institute of Basic Medical Sciences University of Oslo Oslo Norway
| | - Tomas Sakinis
- Medical Division, Radiology and Nuclear Medicine, Neuroimaging Research Group Oslo University Hospital Oslo Norway
| | - Hege Berg Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences University of Oslo Oslo Norway
| | - Benedicte Beichmann
- Department of Nutrition, Institute of Basic Medical Sciences University of Oslo Oslo Norway
| | - Ann‐Monica Fløtten
- Division of Radiology and Nuclear Medicine Oslo University Hospital Oslo Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences University of Oslo Oslo Norway
- Department of Clinical Service, Division of Cancer Medicine Oslo University Hospital Oslo Norway
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Redondo MJ, Balasubramanyam A. Toward an Improved Classification of Type 2 Diabetes: Lessons From Research into the Heterogeneity of a Complex Disease. J Clin Endocrinol Metab 2021; 106:e4822-e4833. [PMID: 34291809 PMCID: PMC8787852 DOI: 10.1210/clinem/dgab545] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Accumulating evidence indicates that type 2 diabetes (T2D) is phenotypically heterogeneous. Defining and classifying variant forms of T2D are priorities to better understand its pathophysiology and usher clinical practice into an era of "precision diabetes." EVIDENCE ACQUISITION AND METHODS We reviewed literature related to heterogeneity of T2D over the past 5 decades and identified a range of phenotypic variants of T2D. Their descriptions expose inadequacies in current classification systems. We attempt to link phenotypically diverse forms to pathophysiology, explore investigative methods that have characterized "atypical" forms of T2D on an etiological basis, and review conceptual frameworks for an improved taxonomy. Finally, we propose future directions to achieve the goal of an etiological classification of T2D. EVIDENCE SYNTHESIS Differences among ethnic and racial groups were early observations of phenotypic heterogeneity. Investigations that uncover complex interactions of pathophysiologic pathways leading to T2D are supported by epidemiological and clinical differences between the sexes and between adult and youth-onset T2D. Approaches to an etiological classification are illustrated by investigations of atypical forms of T2D, such as monogenic diabetes and syndromes of ketosis-prone diabetes. Conceptual frameworks that accommodate heterogeneity in T2D include an overlap between known diabetes types, a "palette" model integrated with a "threshold hypothesis," and a spectrum model of atypical diabetes. CONCLUSION The heterogeneity of T2D demands an improved, etiological classification scheme. Excellent phenotypic descriptions of emerging syndromes in different populations, continued clinical and molecular investigations of atypical forms of diabetes, and useful conceptual models can be utilized to achieve this important goal.
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Affiliation(s)
- Maria J Redondo
- Section of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Hospital, Houston, TX 77030, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
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Sneed NM, Morrison SA. Body Composition Methods in Adults with Type 2 Diabetes or at Risk for T2D: a Clinical Review. Curr Diab Rep 2021; 21:14. [PMID: 33730341 DOI: 10.1007/s11892-021-01381-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW The aim of this study is to summarize anthropometric and advanced methods used to assess body composition in adults diagnosed with type 2 diabetes (T2D) or at risk for T2D that provide clinically relevant information about T2D disease-related complications or risk factors. RECENT FINDINGS Anthropometry is commonly used in clinical settings; however, provides unreliable estimates of fat mass, fat-free mass, and body fat distribution for metabolic health assessments compared to advanced techniques such as bioelectrical impedance analysis (BIA), dual-energy x-ray absorptiometry (DXA), computerized tomography (CT), and magnetic resonance imaging (MRI). Few studies report the clinical use of anthropometric and advanced body composition methods that identify T2D disease-related complications or T2D risk factors. Anthropometry, BIA, DXA, CT, and MRI were used to estimate body adiposity and distribution, visceral and subcutaneous adipose tissue depots, and skeletal muscle mass. Review findings indicate that these methods were capable of identifying clinically relevant T2D disease-related complications such as sarcopenia and T2D risk factors such as obesity or regional adiposity. However, estimates were often sex and race/ethnicity specific warranting cross-validation of these methods in broader populations with T2D or risk for T2D prior to clinical implementation.
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Affiliation(s)
- Nadia Markie Sneed
- School of Nursing, Office of Research and Scholarship, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Shannon A Morrison
- School of Nursing, Department of Family, Community Health, and Systems, University of Alabama at Birmingham, Birmingham, AL, USA
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7
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Strand R, Kullberg J, Ahlström H, Lind L. Relationships between plasma levels and six proinflammatory interleukins and body composition using a new magnetic resonance imaging voxel-based technique. Cytokine X 2021; 3:100050. [PMID: 33604566 PMCID: PMC7885882 DOI: 10.1016/j.cytox.2020.100050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 12/15/2020] [Indexed: 12/20/2022] Open
Abstract
IL-1RA and IL-6 levels were related to traditional DXA and MRI measurements of adipose tissue. Neither IL-6R nor IL-8 or IL-18 showed strong relationships vs the traditional measurements. Weak relationships between IL-16 levels and trunk SAT volume was found by Imiomics. On the contrary, IL-8 levels were related to a reduction of SAT volume.
Background Obesity has previously been linked to inflammation. Here we investigated how plasma levels of six interleukins were related to body fat distribution. Methods In 321 subjects, all aged 50 years, in the population-based POEM study (mean BMI 26–27 kg/m2), six interleukins were measured together with a DXA scan for determination of fat and lean mass. Also a whole-body magnetic resonance imaging (MRI) scan, in which fat content measurements were acquired in > 1 million voxels was performed. Interleukin levels were related to each of these voxels by the voxel-based technique “Imiomics” to create a 3D-view of how these measurements were related to size of each part of the body. Results Levels of IL-1RA and IL-6 were related to traditional DXA and MRI measurements of adipose tissue at all locations. Neither IL-6R, nor IL-8 or IL-18, showed any consistent significant relationships vs the traditional measurements of body composition, while IL-16 showed relationships being of borderline significance. The Imiomics evaluation further strengthen the view that IL-1RA and IL-6 were related to subcutaneous adipose tissue (SAT), as well to ectopic fat distribution. In women, IL-16 levels were weakly related to expansion of SAT in the upper part of the body, while on the contrary, IL-8 levels were related to a reduction of SAT volume. Conclusion Of the six evaluated interleukins, plasma IL-1RA and IL-6 levels were related to the amount of adipose tissue in all parts of the body, while a diverse picture was seen for other interleukins, suggesting that different interleukins are related to fat distribution in different ways.
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Affiliation(s)
- Robin Strand
- Division of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Joel Kullberg
- Division of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Antaros Medical AB, BioVenture Hub, Mölndal, Sweden
| | - Håkan Ahlström
- Division of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Antaros Medical AB, BioVenture Hub, Mölndal, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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8
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Wu L, Zhu W, Qiao Q, Huang L, Li Y, Chen L. Novel and traditional anthropometric indices for identifying metabolic syndrome in non-overweight/obese adults. Nutr Metab (Lond) 2021; 18:3. [PMID: 33407674 PMCID: PMC7788902 DOI: 10.1186/s12986-020-00536-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/14/2020] [Indexed: 02/10/2023] Open
Abstract
Background Metabolic syndrome (MetS) in non-overweight/obese people is insidiously associated with cardiovascular disease. Novel anthropometric indices can reflect central obesity better than the traditional anthropometric indices. Therefore, we hypothesize that these newly developed anthropometric indices can better identify MetS in non-overweight/obese people than conventional indices. Methods Cross-sectional data of sociodemographic, biochemical and anthropometric indices were collected from 2916 non-overweight/obese Chinese people. A body shape index (ABSI), body roundness index (BRI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI) and abdominal volume index (AVI) were calculated. Partial correlation analysis was used to clarify the correlation between anthropometric indices and MetS variables. Binary logistic regression analysis was applied to assess the association between anthropometric indices and MetS and its components. Receiver-operating characteristic curve was used to identify the diagnostic ability of anthropometric indices for MetS and its components. The area under curve (AUC) difference between WHtR and each new anthropometric index was compared in pairs. Results After adjusting for covariates, AVI had the optimal ability of identifying MetS (AUC: 0.743 for male, 0.819 for female) and the strongest correlation with high-density lipoprotein cholesterol (HDL-C) (coe: − 0.227 for male, − 0.207 for female) and the highest odds rations (OR) with low HDL-C group (male: OR = 1.37, female: OR = 1.55). The WHtR was comparable to BRI in assessing MetS (AUC: 0.739 for male, 0.817 for female). WHtR or BRI could also well identify hypertension (AUC: 0.602 for male, 0.688 for female) and dysglycemia (AUC: 0.669 for male, 0.713 for female) and female’s high triglyceride level (AUC 0.712). The recognition ability of the two was equivalent. The ability of ABSI and WWI to identify MetS was weak. Conclusions AVI is the optimal anthropometric indices to identify MetS in non-overweight/obese Chinese adults. BRI and WHtR can also be considered as discriminators, while ABSI and WWI are weak discriminators. WHtR is easy to measure. So, it is recommended as an early preliminary screening method for the MetS in non-overweight/obese people.
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Affiliation(s)
- Lihong Wu
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Wenhua Zhu
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Qiaohua Qiao
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Lijuan Huang
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Yiqi Li
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Liying Chen
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Abstract
An etiologically based classification of diabetes is needed to account for the heterogeneity of type 1 and type 2 diabetes (T1D and T2D) and emerging forms of diabetes worldwide. It may be productive for both classification and clinical discovery to consider variant forms of diabetes as a spectrum. Maturity onset diabetes of youth and neonatal diabetes serve as models for etiologically defined, rare forms of diabetes in the spectrum. Ketosis-prone diabetes is a model for more complex forms, amenable to phenotypic dissection. Bioinformatic approaches such as clustering analyses of large datasets and multi-omics investigations of rare and atypical phenotypes are promising avenues to explore and define new subgroups of diabetes.
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Affiliation(s)
- Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas 77030, USA;
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10
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Analysis of gut microbiota of obese individuals with type 2 diabetes and healthy individuals. PLoS One 2019; 14:e0226372. [PMID: 31891582 PMCID: PMC6938335 DOI: 10.1371/journal.pone.0226372] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) accounts for 90% of diabetes cases worldwide. The majority of T2DM patients are obese. Dysbiosis in the gut microflora is strongly associated with the pathogenesis of obesity and T2DM; however, the microbiome of obese-T2DM individuals in the Pakistani population remains unexplored. The gut microbiota signature of 60 Pakistani adults was studied using 16S rRNA sequencing targeting V3–V4 hypervariable regions. The sequence analysis revealed that bacteria from Firmicutes were predominant along with those from Clostridia and Negativicutes, whereas bacteria from Verrucomicrobia, Bacteroidetes, Proteobacteria, and Elusimicrobia were less abundant among the obese T2DM patients. These data distinctively vary from those in reports on the Indian population. The difference in gut microbiota could presumably be related to the distinct lifestyle and eastern dietary habits (high carbohydrate and fat intake, low fiber intake) and unregulated antibiotic consumption. This is the first study carried out to understand the gut microbiome and its correlation with individual life style of obese T2DM patients in the Pakistani population.
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11
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Kjønigsen LJ, Harneshaug M, Fløtten AM, Karterud LK, Petterson K, Skjolde G, Eggesbø HB, Weedon-Fekjær H, Henriksen HB, Lauritzen PM. Reproducibility of semiautomated body composition segmentation of abdominal computed tomography: a multiobserver study. Eur Radiol Exp 2019; 3:42. [PMID: 31664547 PMCID: PMC6820626 DOI: 10.1186/s41747-019-0122-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
Background Segmentation of computed tomography (CT) images provides quantitative data on body tissue composition, which may greatly impact the development and progression of diseases such as type 2 diabetes mellitus and cancer. We aimed to evaluate the inter- and intraobserver variation of semiautomated segmentation, to assess whether multiple observers may interchangeably perform this task. Methods Anonymised, unenhanced, single mid-abdominal CT images were acquired from 132 subjects from two previous studies. Semiautomated segmentation was performed using a proprietary software package. Abdominal muscle compartment (AMC), inter- and intramuscular adipose tissue (IMAT), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were identified according to pre-established attenuation ranges. The segmentation was performed by four observers: an oncology resident with extensive training and three radiographers with a 2-week training programme. To assess interobserver variation, segmentation of each CT image was performed individually by two or more observers. To assess intraobserver variation, three of the observers did repeated segmentations of the images. The distribution of variation between subjects, observers and random noise was estimated by a mixed effects model. Inter- and intraobserver correlation was assessed by intraclass correlation coefficient (ICC). Results For all four tissue compartments, the observer variations were far lower than random noise by factors ranging from 1.6 to 3.6 and those between subjects by factors ranging from 7.3 to 186.1. All interobserver ICC was ≥ 0.938, and all intraobserver ICC was ≥ 0.996. Conclusions Body composition segmentation showed a very low level of operator dependability. Multiple observers may interchangeably perform this task with highly reproducible results. Electronic supplementary material The online version of this article (10.1186/s41747-019-0122-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Magnus Harneshaug
- The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ann-Monica Fløtten
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Lena Korsmo Karterud
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kent Petterson
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Grethe Skjolde
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Heidi B Eggesbø
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Harald Weedon-Fekjær
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Hege Berg Henriksen
- Division of Clinical Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Peter M Lauritzen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
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12
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Magnussen LV, Andersen PE, Diaz A, Ostojic J, Højlund K, Hougaard DM, Christensen AN, Nielsen TL, Andersen M. MR spectroscopy of hepatic fat and adiponectin and leptin levels during testosterone therapy in type 2 diabetes: a randomized, double-blinded, placebo-controlled trial. Eur J Endocrinol 2017; 177:157-168. [PMID: 28522646 DOI: 10.1530/eje-17-0071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/30/2017] [Accepted: 05/18/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Men with type 2 diabetes mellitus (T2D) often have lowered testosterone levels and an increased risk of cardiovascular disease (CVD). Ectopic fat increases the risk of CVD, whereas subcutaneous gluteofemoral fat protects against CVD and has a beneficial adipokine-secreting profile. HYPOTHESIS Testosterone replacement therapy (TRT) may reduce the content of ectopic fat and improve the adipokine profile in men with T2D. DESIGN AND METHODS A randomized, double-blinded, placebo-controlled study in 39 men aged 50-70 years with T2D and bioavailable testosterone levels <7.3 nmol/L. Patients were randomized to TRT (n = 20) or placebo gel (n = 19) for 24 weeks. Thigh subcutaneous fat area (TFA, %fat of total thigh volume), subcutaneous abdominal adipose tissue (SAT, % fat of total abdominal volume) and visceral adipose tissue (VAT, % fat of total abdominal volume) were measured by magnetic resonance (MR) imaging. Hepatic fat content was estimated by single-voxel MR spectroscopy. Adiponectin and leptin levels were measured by in-house immunofluorometric assay. Coefficients (b) represent the placebo-controlled mean effect of intervention. RESULTS TFA (b = -3.3 percentage points (pp), P = 0.009), SAT (b = -3.0 pp, P = 0.006), levels of adiponectin (b = -0.4 mg/L, P = 0.045), leptin (b = -4.3 µg/mL, P < 0.001), leptin:adiponectin ratio (b = -0.53, P = 0.001) and HDL cholesterol (b = -0.11 mmol/L, P = 0.009) decreased during TRT compared with placebo. Hepatic fat content and VAT were unchanged. CONCLUSIONS The effects of TRT on cardiovascular risk markers were ambiguous. We observed potentially harmful changes in cardiovascular risk parameters, markedly reduced subcutaneous fat and unchanged ectopic fat during TRT and a reduction in adiponectin levels. On the other hand, the decrease in leptin and leptin:adiponectin ratio assessments could reflect an amelioration of the cardiovascular risk profile linked to hyperleptinaemia in ageing men with T2D.
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Affiliation(s)
| | - P E Andersen
- Departments of Radiology, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - A Diaz
- Departments of Radiology, Odense University Hospital, Odense, Denmark
| | - J Ostojic
- Centre of Radiology, Clinical Centre of Vojvodina, Faculty of Medicine-University of Novi Sad, Novi Sad, Serbia
| | - K Højlund
- Departments of Endocrinology and Metabolism
- Section of Molecular Diabetes & Metabolism, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - D M Hougaard
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - A N Christensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | | | - M Andersen
- Departments of Endocrinology and Metabolism
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13
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Sommer C, Jenum AK, Waage CW, Mørkrid K, Sletner L, Birkeland KI. Ethnic differences in BMI, subcutaneous fat, and serum leptin levels during and after pregnancy and risk of gestational diabetes. Eur J Endocrinol 2015; 172:649-56. [PMID: 25740849 DOI: 10.1530/eje-15-0060] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/04/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To explore the differences between Europeans and South Asians in BMI, subcutaneous fat, and serum leptin (s-leptin) levels during and after pregnancy and their relationship with gestational diabetes (GDM). DESIGN Multi-ethnic population-based cohort study, whereof 353 Europeans (93.1% of the included) and 190 South Asians (95.0% of the included). METHODS S-leptin, BMI, and subcutaneous fat (sum of triceps, subscapular, and suprailiac skinfolds) were measured at 14 and 28 weeks of gestation, and 14 weeks after delivery. GDM was diagnosed with the WHO criteria 2013. RESULTS South Asians had similar thickness of the triceps and suprailiac skinfolds, thicker subscapular skinfold, and higher s-leptin than Europeans in early pregnancy, despite lower BMI. South Asians retained more subcutaneous fat (mean (95% CI) 10.0 (7.4-12.7) mm vs 3.8 (1.9-5.8) mm) and BMI (1.5 (1.2-1.8) kg/m(2) vs 0.1 (-0.1 to 0.3) kg/m(2)) than Europeans 14 weeks after delivery and s-leptin decreased less in South Asians than Europeans (-0.13 (-0.27 to -0.00) μg/l vs -0.47 (-0.57 to -0.37) μg/l, P<0.001 for all). The prevalence of GDM was 23.8% (n=84) in Europeans and 42.6% (n=81) in South Asians. BMI, subcutaneous fat, and s-leptin were all positively associated with GDM, also after adjustment for covariates. CONCLUSIONS The relatively high amounts of subcutaneous fat and s-leptin in South Asians in early pregnancy contributed to their increased risk of GDM. South Asians retained more weight and subcutaneous fat after delivery, potentially increasing their risk of adiposity and GDM in future pregnancies.
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Affiliation(s)
- Christine Sommer
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway
| | - Anne K Jenum
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway
| | - Christin W Waage
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway
| | - Kjersti Mørkrid
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway
| | - Line Sletner
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway
| | - Kåre I Birkeland
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University Hospital, PO Box 4959 Nydalen, N-0424 Oslo, NorwayFaculty of MedicineInstitute of Clinical MedicineDepartment of General PracticeFaculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, NorwayFaculty of Health SciencesOslo and Akershus University College of Applied Sciences, Oslo, NorwayDepartment of International Public HealthNorwegian Institute of Public Health, Oslo, NorwayDepartment of Child and Adolescents MedicineAkershus University Hospital, Lørenskog, Norway
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14
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Wium C. Authors' response to letter: 'proper assessment of leptin results with confounders'. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:440. [PMID: 25916835 DOI: 10.3109/00365513.2015.1035749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cecilie Wium
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital , Nydalen, Oslo , Norway
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15
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Sertoglu E, Tapan S. Proper assessment of leptin results with confounders. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:438-9. [PMID: 25916836 DOI: 10.3109/00365513.2015.1033744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erdim Sertoglu
- Ankara Mevki Military Hospital, Anittepe Dispensary, Biochemistry Laboratory , Ankara , Turkey
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16
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Agilli M, Aydin FN, Cayci T, Kurt YG. Evaluation of leptin in subjects with type 2 diabetes mellitus. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:434-5. [PMID: 25874480 DOI: 10.3109/00365513.2015.1033742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mehmet Agilli
- Department of Biochemistry, Agri Military Hospital , Agri
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