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Chen S, Hu Z, Tang J, Zhu H, Zheng Y, Xiao J, Xu Y, Wang Y, Luo Y, Mo X, Wu Y, Guo J, Zhang Y, Luo H. High temperature and humidity in the environment disrupt bile acid metabolism, the gut microbiome, and GLP-1 secretion in mice. Commun Biol 2024; 7:465. [PMID: 38632312 PMCID: PMC11024098 DOI: 10.1038/s42003-024-06158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
High temperature and humidity in the environment are known to be associated with discomfort and disease, yet the underlying mechanisms remain unclear. We observed a decrease in plasma glucagon-like peptide-1 levels in response to high-temperature and humidity conditions. Through 16S rRNA gene sequencing, alterations in the gut microbiota composition were identified following exposure to high temperature and humidity conditions. Notably, changes in the gut microbiota have been implicated in bile acid synthesis. Further analysis revealed a decrease in lithocholic acid levels in high-temperature and humidity conditions. Subsequent in vitro experiments demonstrated that lithocholic acid increases glucagon-like peptide-1 secretion in NCI-H716 cells. Proteomic analysis indicated upregulation of farnesoid X receptor expression in the ileum. In vitro experiments revealed that the combination of lithocholic acid with farnesoid X receptor inhibitors resulted in a significant increase in GLP-1 levels compared to lithocholic acid alone. In this study, we elucidate the mechanism by which reduced lithocholic acid suppresses glucagon-like peptide 1 via farnesoid X receptor activation under high-temperature and humidity condition.
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Affiliation(s)
- Song Chen
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zongren Hu
- Department of Rehabilitation and Healthcare, Hunan University of Medicine, Huaihua, China
| | - Jianbang Tang
- Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, China
| | | | - Yuhua Zheng
- School of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiedong Xiao
- School of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Youhua Xu
- Faculty of Chinese Medicine, State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macao, China
| | - Yao Wang
- School of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Luo
- School of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoying Mo
- School of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yalan Wu
- School of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianwen Guo
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Yongliang Zhang
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Immunology Programme, The Life Science Institute, National University of Singapore, Singapore, Singapore.
| | - Huanhuan Luo
- School of Basic Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Chen C, Huang Y, Zeng Y, Lu X, Dong G. Targeting the DPP-4-GLP-1 pathway improves exercise tolerance in heart failure patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2019; 19:311. [PMID: 31870322 PMCID: PMC6927173 DOI: 10.1186/s12872-019-01275-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/22/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The most significant manifestation of heart failure is exercise intolerance. This systematic review and meta-analysis was performed to investigate whether dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon-like peptide 1 receptor agonists (GLP-1 RAs), widely used anti-diabetic drugs, could improve exercise tolerance in heart failure patients with or without type 2 diabetes mellitus. METHODS An electronic search of PubMed, EMBASE and the Cochrane Library was carried out through March 8th, 2019, for eligible trials. Only randomized controlled studies were included. The primary outcome was exercise tolerance [6-min walk test (6MWT) and peak O2 consumption], and the secondary outcomes included quality of life (QoL), adverse events (AEs) and all-cause death. RESULT After the literature was screened by two reviewers independently, four trials (659 patients) conducted with heart failure patients with or without type 2 diabetes met the eligibility criteria. The results suggested that targeting the DPP-4-GLP-1 pathway can improve exercise tolerance in heart failure patients [MD 24.88 (95% CI 5.45, 44.31), P = 0.01] without decreasing QoL [SMD -0.51 (95% CI -1.13, 0.10), P = 0.10]; additionally, targeting the DPP-4-GLP-1 pathway did not show signs of increasing the incidence of serious AEs or mortality. CONCLUSION Our results suggest that DPP-4 inhibitors or GLP-1 RAs improve exercise tolerance in heart failure patients. Although the use of these drugs for heart failure has not been approved by any organization, they may be a better choice for type 2 diabetes mellitus patients with heart failure. Furthermore, as this pathway contributes to the improvement of exercise tolerance, it may be worth further investigation in exercise-intolerant patients with other diseases.
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Affiliation(s)
- Chengcong Chen
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Ying Huang
- School of Public Health, Chinese University of Hong Kong, Hong Kong, China
| | - Yongmei Zeng
- Section of Gastroenterology, Department of Pediatrics, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, China
| | - Xiyan Lu
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Guoqing Dong
- Section of Endocrinology, Department of Pediatrics, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
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Rix I, Steen Pedersen J, Storgaard H, Gluud LL. Cardiometabolic effects of antidiabetic drugs in non-alcoholic fatty liver disease. Clin Physiol Funct Imaging 2018; 39:122-127. [PMID: 29808958 DOI: 10.1111/cpf.12526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/04/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) affects about 25% of the population worldwide. NAFLD may be viewed as the hepatological manifestation of metabolic syndrome. Patients with metabolic syndrome due to diabetes or obesity have an increased risk of cardiovascular disease. This narrative review describes cardiometabolic effects of antidiabetic drugs in NAFLD. METHODS We conducted a systematic search in PubMed and manually scanned bibliographies in trial databases and reference lists in relevant articles. RESULTS Heart disease is the leading cause of death in NAFLD. Conversely, NAFLD is an independent cardiovascular risk factor in patients suffering from metabolic syndrome. NAFLD is associated with markers of atherosclerosis, and patients have increased risk of ischaemic heart disease. Additionally, patients with NAFLD have increased risk of cardiac dysfunction and heart failure. There are no randomized controlled trials showing clear effects of medical treatment on clinical outcomes in patients with NAFLD. However, based on evidence from small trials and extrapolation from trials evaluating patients with type 2 diabetes, some antidiabetic drugs may be beneficial on cardiovascular function in patients with NAFLD. CONCLUSION At present, there is promising evidence of a potential effect of antidiabetic drugs for patients with NAFLD. Future studies should address the treatment of NAFLD and the liver-related consequences but also aim at improving the cardiometabolic outcomes.
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Affiliation(s)
- Iben Rix
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Julie Steen Pedersen
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Heidi Storgaard
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Lise Lotte Gluud
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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Angelini A, Pi X, Xie L. Dioxygen and Metabolism; Dangerous Liaisons in Cardiac Function and Disease. Front Physiol 2017; 8:1044. [PMID: 29311974 PMCID: PMC5732914 DOI: 10.3389/fphys.2017.01044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 12/19/2022] Open
Abstract
The heart must consume a significant amount of energy to sustain its contractile activity. Although the fuel demands are huge, the stock remains very low. Thus, in order to supply its daily needs, the heart must have amazing adaptive abilities, which are dependent on dioxygen availability. However, in myriad cardiovascular diseases, “fuel” depletion and hypoxia are common features, leading cardiomyocytes to favor low-dioxygen-consuming glycolysis rather than oxidation of fatty acids. This metabolic switch makes it challenging to distinguish causes from consequences in cardiac pathologies. Finally, despite the progress achieved in the past few decades, medical treatments have not improved substantially, either. In such a situation, it seems clear that much remains to be learned about cardiac diseases. Therefore, in this review, we will discuss how reconciling dioxygen availability and cardiac metabolic adaptations may contribute to develop full and innovative strategies from bench to bedside.
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Affiliation(s)
- Aude Angelini
- Department of Medicine-Athero and Lipo, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, United States
| | - Xinchun Pi
- Department of Medicine-Athero and Lipo, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, United States
| | - Liang Xie
- Department of Medicine-Athero and Lipo, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, United States
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Tan X, Cao X, Zhou M, Zou P, Hu J. Efficacy and safety of once-weekly semaglutide for the treatment of type 2 diabetes. Expert Opin Investig Drugs 2017; 26:1083-1089. [PMID: 28741970 DOI: 10.1080/13543784.2017.1360274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Type 2 diabetes is a chronic metabolic disease characterized by persistent hyperglycemia resulting from progressive deficient of insulin in patients with a background of insulin resistance. Current treatment algorithms recommended by American Diabetes Association/The European Association for the Study of Diabetes promote a patient-centered approach that takes into account a comprehensive consideration of pharmacological properties of drugs, including glucose-lowering action, effects on body weight, correction on multiple pathophysiologic defects, tolerability, and long-term safety. Glucagon-likepeptide1 (GLP-1) receptor analogues are appealing due to the improved glycemic control in a glucose-dependent manner, modest weight loss and low risk of hypoglycemia. Areas covered: Semaglutide (Novo Nordisk), a once-weekly GLP-1 analogue, is currently in the phase III clinical trial for the treatment of type 2 diabetes. This article aims to review the pharmacological and clinical profiles of semaglutide based on the available clinical data. Expert opinion: Semaglutide achieved greater reduction from baseline in HbA1c in comparison to placebo. The greater proportion of patients in semaglutide group than that in placebo group achieved target HbA1c <7.0% and <6.5%, respectively. Semaglutide is the second GLP-1 analogue contributing to the reduced bodyweight and improving obesity related complications. More importantly, semaglutide is beneficial to diabetic patients with high cardiovascular risk according to the recently completed phase III trial. The incidence of gastrointestinal adverse effects increased with semaglutide dose.
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Affiliation(s)
- Xueying Tan
- a College of Pharmacy , Zhejiang Pharmaceutical College , Ningbo , China
| | - Xiaojing Cao
- b Department of Pharmacy , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , China
| | - Minzhi Zhou
- c School of Medicine , Zhejiang University City College , Hangzhou , China
| | - Ping Zou
- d Department of Pharmacy , The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Jingbo Hu
- e College of Pharmaceutical Science , Zhejiang University , Hangzhou , China
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Gurgle HE, White K, McAdam-Marx C. SGLT2 inhibitors or GLP-1 receptor agonists as second-line therapy in type 2 diabetes: patient selection and perspectives. Vasc Health Risk Manag 2016; 12:239-49. [PMID: 27350752 PMCID: PMC4902150 DOI: 10.2147/vhrm.s83088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Controversy exists regarding the selection of second-line therapy for patients with type 2 diabetes mellitus (T2DM) who are unable to achieve glycemic control with metformin therapy alone. Newer pharmacologic treatments for T2DM include glucagon-like peptide-1 receptor agonists and sodium–glucose cotransporter 2 inhibitors. Both the classes of medication are efficacious, exhibit positive effects on weight, and are associated with minimal risk of hypoglycemia. The purpose of this review is to compare the clinical trial and real-world effectiveness data of glucagon-like peptide-1 receptor agonists versus sodium–glucose cotransporter 2 inhibitors related to A1c reduction, weight loss, cost-effectiveness, cardiovascular outcomes, and safety in patients with T2DM. This review summarizes comparative evidence for providers who are determining which of the two classes may be the most appropriate for a specific patient.
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Affiliation(s)
- Holly E Gurgle
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Karen White
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Carrie McAdam-Marx
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
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Li L, Li S, Liu J, Deng K, Busse JW, Vandvik PO, Wong E, Sohani ZN, Bala MM, Rios LP, Malaga G, Ebrahim S, Shen J, Zhang L, Zhao P, Chen Q, Wang Y, Guyatt GH, Sun X. Glucagon-like peptide-1 receptor agonists and heart failure in type 2 diabetes: systematic review and meta-analysis of randomized and observational studies. BMC Cardiovasc Disord 2016; 16:91. [PMID: 27169565 PMCID: PMC4863354 DOI: 10.1186/s12872-016-0260-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/29/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The effect of glucagon-like peptide-1(GLP-1) receptor agonists on heart failure remains uncertain. We therefore conducted a systematic review to assess the possible impact of GLP-1 agonists on heart failure or hospitalization for heart failure in patients with type 2 diabetes. METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov to identify randomized controlled trials (RCTs) and observational studies that addressed the effect of GLP-1 receptor agonists in adults with type 2 diabetes, and explicitly reported heart failure or hospitalization for heart failure. Two paired reviewers screened reports, collected data, and assessed the risk of bias. We pooled data from RCTs and observational studies separately, and used the GRADE approach to rate the quality of evidence. RESULTS We identified 25 studies that were eligible for our review; 21 RCTs (n = 18,270) and 4 observational studies (n = 111,029). Low quality evidence from 20 RCTs suggested, if anything, a lower incidence of heart failure between GLP-1 agonists versus control (17/7,441 vs. 19/4,317; odds ratio (OR) 0.62, 95 % confidence interval (CI) 0.31 to 1.22; risk difference (RD) 19 fewer, 95 % CI 34 fewer to 11 more per 1000 over 5 years). Three cohort studies comparing GLP-1 agonists to alternative agents provided very low quality evidence that GLP-1 agonists do not increase the incidence of heart failure. One RCT provided moderate quality evidence that GLP-1 agonists were not associated with hospitalization for heart failure (lixisenatide vs placebo: 122/3,034 vs. 127/3,034; adjusted hazard ratio 0.96, 95 % CI 0.75 to 1.23; RD 4 fewer, 95 % CI 25 fewer to 23 more per 1000 over 5 years) and a case-control study provided very low quality evidence also suggesting no association (GLP-1 agonists vs. other anti-hyperglycemic drugs: 1118 cases and 17,626 controls, adjusted OR 0.67, 95 % CI 0.32 to 1.42). CONCLUSIONS The current evidence suggests that GLP-1 agonists do not increase the risk of heart failure or hospitalization for heart failure among patients with type 2 diabetes.
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Affiliation(s)
- Ling Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiali Liu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China
| | - Ke Deng
- West China school of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Jason W Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Per Olav Vandvik
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway.,Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | - Evelyn Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zahra N Sohani
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland.,Systematic Reviews Unit-Polish Cochrane Branch, Jagiellonian University Medical College, Krakow, Poland
| | - Lorena P Rios
- Internal Medicine Unit, Hospital Clinico FUSAT, Rancagua, Chile
| | - German Malaga
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Shanil Ebrahim
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Anesthesia, McMaster University, Hamilton, ON, Canada.,Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, USA.,Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jiantong Shen
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China
| | - Longhao Zhang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China
| | - Pujing Zhao
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China
| | - Qunfei Chen
- The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yingqiang Wang
- Department of Medical Administration, 363 Hospital, Chengdu, Sichuan, China
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, 610041, Sichuan, China.
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Gaspari T, Brdar M, Lee HW, Spizzo I, Hu Y, Widdop RE, Simpson RW, Dear AE. Molecular and cellular mechanisms of glucagon-like peptide-1 receptor agonist-mediated attenuation of cardiac fibrosis. Diab Vasc Dis Res 2016; 13:56-68. [PMID: 26408644 DOI: 10.1177/1479164115605000] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Glucagon-like peptide-1 receptor agonists may have a role in modulation of cardiac fibrosis. Our study aimed to determine the effect of the glucagon-like peptide-1 receptor agonist liraglutide in obesity, hypertension and age-induced murine models of cardiac fibrosis and identify associated molecular mechanisms. METHODS C57Bl/6J mice on a high-fat diet and C57Bl/6J mice on a normal chow diet treated with angiotensin II were used to induce obesity and hypertension-mediated cardiac fibrosis, respectively. C57Bl/6J mice 20 months old were used to study age-induced cardiac fibrosis. Liraglutide treatment of 30 µg/kg/day-300 µg/kg s.c. twice daily was administered for 4 weeks. RESULTS Liraglutide treatment attenuated obesity, hypertension and age-induced increases in interstitial cardiac fibrosis and expression of inflammatory and oxidative stress markers. CONCLUSIONS These observations identify a potential role for liraglutide in the prevention of cardiac fibrosis and identify molecular mechanisms associated with these effects.
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Affiliation(s)
- Tracey Gaspari
- Department of Pharmacology, Monash University, Melbourne, VIC, Australia
| | - Melita Brdar
- Department of Pharmacology, Monash University, Melbourne, VIC, Australia
| | - Huey Wen Lee
- Department of Pharmacology, Monash University, Melbourne, VIC, Australia
| | - Iresha Spizzo
- Department of Pharmacology, Monash University, Melbourne, VIC, Australia
| | - Yunshan Hu
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Robert E Widdop
- Department of Pharmacology, Monash University, Melbourne, VIC, Australia
| | - Richard W Simpson
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Anthony E Dear
- Department of Medicine, Monash University, Melbourne, VIC, Australia
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Comparing the Amount of Disorder of Practical-thought Obsession in the Young Male Athlete and Non-athlete People
I J C T A, 8(2) December 2015, pp. 629-633 © International Science Press. DER DIABETOLOGE 2015. [DOI: 10.1007/s11428-015-0036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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