Association of Thigh Muscle Mass with Insulin Resistance and Incident Type 2 Diabetes Mellitus in Japanese Americans

Association between macro- and microvascular damage and sarcopenia index in individuals with type 2 diabetes mellitus

Sarcopenia was recently reported to be relevant to an increased macro-and microvascular disease risk. Sarcopenia index (SI) has been identified as a surrogate marker for sarcopenia. The aim of the present study was to investigate the association between macro- and microvascular disease and SI in patients with type 2 diabetes mellitus (T2DM). A total of 783 patients with T2DM were enrolled in this cross-sectional study. The SI was calculated by (serum creatinine [mg/dL]/cystatin C [mg/L]) × 100. The subjects were divided into three groups according to SI tertiles: T1 (41.27-81.37), T2 (81.38- 99.55), and T3 (99.56-192.31). Parameters of macro- and microvascular complications, including diabetic retinopathy (DR), micro- and macroalbuminuria (MAU), diabetic peripheral neuropathy (DPN), and lower extremity peripheral artery disease (LEAD) were evaluated. Multivariate logistic regression analysis revealed that when taking the top tertile of SI as a reference, an increasing trend of the prevalence of DR, MAU, DPN, and LEAD were presented (all P for trend  < 0.05), where the OR (95% CI) for DR prevalence was 1.967 (1.252-3.090) in T2, 2.195 (1.278-3.769) in T1, for MAU was 1.805 (1.149-2.837) in T2, 2.537 (1.490-4.320) in T1, for DPN was 2.244 (1.485-3.391) in T2, 3.172 (1.884-5.341) in T1, and for LEAD was 2.017 (1.002-4.057) in T2, 2.405 (1.107-5.225) in T1 (all P < 0.05). Patients with lower SI were more inclined to have an increased risk of macro- and microvascular damage in T2DM population, which may be related to sarcopenia.

Shape phenotype of thigh fat and muscle and risk of major adverse cardiovascular events after fragility hip fracture

BACKGROUND

Although sarcopenia has been recognized as a predictor of mortality in elderly patients with hip fracture, the association of thigh fat and muscle with cardiovascular (CV) outcome remains unclear. We examined the impact of computed tomography (CT)-derived shape features of thigh fat and muscle on major adverse CV events (MACE) in elderly patients with hip fracture.

METHODS

We conducted a retrospective analysis of consecutive patients aged ≥65 years who presented with hip fracture confirmed on pelvic bone CT scan and underwent hip fracture surgery at our institution from April 2019 to December 2021. The cross-sectional area (CSA) and compactness (CM) of both the muscle and fat at the upper-thigh level were calculated from two-dimensional CT images using AVIEW Research (v1.1.38, Coreline Soft, Co. Ltd, Seoul, South Korea). The shape features of thigh fat and muscle were categorized into four groups based on the combination of CSA and CM: fat CSA (fat area [FA])/fat CM (FCM), muscle CSA (muscle area [MA])/muscle CM (MCM), FA/MCM and MA/FCM. In each of them, subjects were categorized into four subgroups: high CSA/high CM, high CSA/low CM, low CSA/high CM and low CSA/low CM. The primary outcome was MACE after 30 days of surgery, defined as a composite of all-cause death, acute myocardial infarction, stroke or hospitalization for heart failure.

RESULTS

Of 356 patients enrolled (median age, 82 years; 76.7% females), 72 (20.2%) had MACE over a median follow-up of 13.1 months (ranges 5.9-21.0 months). Patients with MACE had a significantly lower median FA (193.7 vs. 226.2 cm2 , P < 0.0001) and FCM (0.443 vs. 0.513, P = 0.001) compared with those without MACE, but no significant differences were found in MA, MCM and FA-MA ratio between the two groups. In a multivariate Cox regression analysis, low FA (<240.1 cm2 ) (adjusted hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.39-6.44, P = 0.005) and low FCM (<0.477) (adjusted HR 2.00, 95% CI 1.10-3.63, P = 0.023) were associated with an increased risk of MACE. Among the shape phenotypes of thigh fat and muscle, the thigh fat phenotype of low FA/low FCM (adjusted HR 3.13, 95% CI 1.81-5.42, P < 0.0001 [reference, high FA/high FCM]) was found to be an independent predictor of MACE.

CONCLUSIONS

In elderly patients with fragility hip fracture, thigh CT-derived measures of FA and FCM may provide useful prognostic information for predicting adverse CV outcomes.

More appendicular lean mass relative to body mass index is associated with lower incident diabetes in middle-aged adults in the CARDIA study

BACKGROUND AND AIMS

Although lower lean mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data specifically in middle-aged Black and White adults are lacking. Relative appendicular lean mass (ALM), such as ALM adjusted for body mass index (BMI), is important to consider since muscle mass is associated with overall body size. We investigated whether ALM/BMI is associated with incident type 2 diabetes in the Coronary Artery Risk Development in Young Adults study.

METHODS AND RESULTS

1893 middle-aged adults (55% women) were included. ALM was measured by DXA in 2005-06. Incident type 2 diabetes was defined in 2010-11 or 2015-16 as fasting glucose ≥7 mmol/L (126 mg/dL), 2-h glucose on OGTT ≥11.1 mmol/L (200 mg/dL) (2010-11 only), HbA1C ≥48 mmol/mol (6.5%) (2010-11 only), or glucose-lowering medications. Cox regression models with sex stratification were performed. In men and women, ALM/BMI was 1.07 ± 0.14 (mean ± SD) and 0.73 ± 0.12, respectively. Seventy men (8.2%) and 71 women (6.8%) developed type 2 diabetes. Per sex-specific SD higher ALM/BMI, unadjusted diabetes risk was lower by 21% in men [HR 0.79 (0.62-0.99), p = 0.04] and 29% in women [HR 0.71 (0.55-0.91), p = 0.008]. After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association was no longer significant. Adjustment for waist circumference accounted for the attenuation in men.

CONCLUSION

Although more appendicular lean mass relative to BMI is associated with lower incident type 2 diabetes in middle-aged men and women over 10 years, its effect may be through other metabolic risk factors such as waist circumference, which is a correlate of abdominal fat mass.

HOMA-IR as a predictor of Health Outcomes in Patients with Metabolic Risk Factors: A Systematic Review and Meta-analysis

INTRODUCTION

There exists clinical interest in the following question: Is there an association between HOMA-IR and the risk of developing metabolic diseases?

AIMS

Assessing the association between high values of HOMA-IR with the incidence of T2DM, MACE, essential hypertension, dyslipidemia, NASH, and cancer in healthy participants and participants with a component of metabolic syndrome.

METHODS

Databases were searched by an experienced librarian to find eligible studies. Observational cohort studies enrolling healthy adults and adults with metabolic syndrome components that evaluated HOMA as a marker of IR were considered for inclusion. Eligibility assessment, data extraction and risk of bias assessment were performed independently and in duplicate. Baseline characteristics of patients, cutoff values of HOMA-IR to predict metabolic events were extracted independently and in duplicate.

RESULTS

38 studies (215,878 participants) proved eligible. A higher HOMA-IR value had a significant effect on the risk of developing T2DM (HR 1.87; CI 1.40-2.49), presenting non-fatal MACE (HR 1.46; CI 1.08-1.97) and hypertension (HR 1.35; CI 1.15-1.59). No association was found regarding cancer mortality and fatal MACE with higher HOMA-IR values, there was not enough information to carry out a meta-analysis to establish an association between higher values of HOMA with cancer incidence, dyslipidemia, and NASH.

CONCLUSIONS

High values of HOMA were associated with an increased risk of diabetes, hypertension, and non-fatal MACE; yet, not for cardiovascular or cancer mortality. More research is needed to determine the value of the HOMA index in metabolic and cardiovascular outcomes.

PROSPERO REGISTRATION NUMBER

CRD42020187645.

Synergistic Interaction between Hyperuricemia and Abdominal Obesity as a Risk Factor for Metabolic Syndrome Components in Korean Population

BACKGROUND

The present study investigated the role of synergistic interaction between hyperuricemia and abdominal obesity as a risk factor for the components of metabolic syndrome.

METHODS

We performed a cross-sectional study using the data of 16,094 individuals from the seventh Korean National Health and Nutrition Examination Survey (2016 to 2018). The adjusted odds ratios of metabolic syndrome and its components were analyzed by multivariate logistic regression analysis. The presence of synergistic interaction between hyperuricemia and abdominal obesity was evaluated by calculating the additive scales-the relative excess risk due to interaction, attributable proportion due to interaction, and synergy index (SI).

RESULTS

There was a synergistic interaction between hyperuricemia and abdominal obesity in hypertriglyceridemia (men: SI, 1.39; 95% confidence interval [CI], 1.01 to 1.98; women: SI, 1.61; 95% CI, 1.02 to 2.69), and low high-density lipoprotein cholesterol (HDL-C) (men: SI, 2.03; 95% CI, 1.41 to 2.91; women: SI, 1.70; 95% CI, 1.05 to 2.95). There was no significant synergistic interaction between hyperuricemia and abdominal obesity for the risk of high blood pressure (men: SI, 1.22; 95% CI, 0.85 to 1.77; women: SI, 1.53; 95% CI, 0.79 to 2.97), and hyperglycemia (men: SI, 1.03; 95% CI, 0.72 to 1.47; women: SI, 1.39; 95% CI, 0.75 to 2.57).

CONCLUSION

Hyperuricemia and abdominal obesity synergistically increased the risk of hypertriglyceridemia and low HDL-C in both sexes.

Is imaging-based muscle quantity associated with risk of diabetes? A meta-analysis of cohort studies

AIMS

Greater muscle quantity (muscle mass and area) is associated with better glycemic control in adults, but its longitudinal association with risk of diabetes remains debatable. We therefore conducted this meta-analysis to address this issue.

METHODS

We performed a literature search and included cohort studies that measured muscle quantity objectively by imaging-based approaches and reported their association with risk of diabetes. Study-specific data were pooled using a random-effects model.

RESULTS

Thirty-three unique datasets, with 10 on total muscle quantity, and 23 on regional (8 on appendicular, 4 on leg, 6 on thigh, and 5 on abdominal) muscle quantity, were included. Muscle quantity was all measured by dual energy x-ray absorptiometry or computed tomography. Most datasets revealed nonsignificant outcomes. Meta-analysis showed collectively that the risk of diabetes was not related to total or regional muscle quantity in either normalized or unnormalized form, with the hazard ratios ranged from 0.92 to 1.09 per every 1 standard deviation higher of corresponding muscle quantity in general (all P > 0.10). Neither sex nor weight status affected the relationship.

CONCLUSIONS

Our study did not provide adequate evidence to support the concept that large muscle quantity was associated with low risk of diabetes in population-based cohort studies.

Association of serum creatinine levels and risk of type 2 diabetes mellitus in Korea: a case control study

BACKGROUND

Reduced skeletal muscle has been suggested as a potential risk factor for type 2 diabetes mellitus (T2DM). Serum creatinine is the primary metabolite of creatine in skeletal muscle. Therefore, low serum creatinine levels may be associated with an increased risk of T2DM. We aimed to evaluate the association between serum creatinine levels and the risk of T2DM in Korea.

METHODS

We analyzed a total of 264,832 nondiabetic adults older than 40 years of age who had undergone a national health examination at least once from 2009 to 2015 in the Korean National Health Insurance Service Cohort. Hazard ratios for T2DM were calculated.

RESULTS

In men, serum creatinine levels and the risk for T2DM showed an inverse J-shaped association. This association was confirmed after adjustment for age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting plasma glucose. In women, there was a trend that serum creatinine levels were inversely associated with the risk of T2DM among those with serum creatinine below 1.1 mg/dl. However, serum creatinine levels were not significantly associated with the risk of T2DM after adjustment for age, BMI, SBP, DBP, and fasting plasma glucose.

CONCLUSIONS

Reduced levels of serum creatinine were significantly associated with an increased risk of T2DM in men with creatinine below 1.20 mg/dl. There was a trend that decreased levels of serum creatinine were associated with an increased risk of T2DM among women with serum creatinine below 1.1 mg/dl, although this result was not statistically significant.

Effects of Exercise Intervention on Type 2 Diabetes Patients With Abdominal Obesity and Low Thigh Circumference (EXTEND): Study Protocol for a Randomized Controlled Trial

INTRODUCTION

Type 2 diabetes patients have abdominal obesity and low thigh circumference. Previous studies have mainly focused on the role of exercise in reducing body weight and fat mass, improving glucose and lipid metabolism, with a lack of evaluation on the loss of muscle mass, diabetes complications, energy metabolism, and brain health. Moreover, whether the potential physiological benefit of exercise for diabetes mellitus is related to the modulation of the microbiota-gut-brain axis remains unclear. Multi-omics approaches and multidimensional evaluations may help systematically and comprehensively correlate physical exercise and the metabolic benefits.

METHODS AND ANALYSIS

This study is a randomized controlled clinical trial. A total of 100 sedentary patients with type 2 diabetes will be allocated to either an exercise or a control group in a 1:1 ratio. Participants in the exercise group will receive a 16-week combined aerobic and resistance exercise training, while those in the control group will maintain their sedentary lifestyle unchanged. Additionally, all participants will receive a diet administration to control the confounding effects of diet. The primary outcome will be the change in body fat mass measured using bioelectrical impedance analysis. The secondary outcomes will include body fat mass change rate (%), and changes in anthropometric indicators (body weight, waist, hip, and thigh circumference), clinical biochemical indicators (glycated hemoglobin, blood glucose, insulin sensitivity, blood lipid, liver enzyme, and renal function), brain health (appetite, mood, and cognitive function), immunologic function, metagenomics, metabolomics, energy expenditure, cardiopulmonary fitness, exercise-related indicators, fatty liver, cytokines (fibroblast growth factor 21, fibroblast growth factor 19, adiponectin, fatty acid-binding protein 4, and lipocalin 2), vascular endothelial function, autonomic nervous function, and glucose fluctuation.

DISCUSSION

This study will evaluate the effect of a 16-week combined aerobic and resistance exercise regimen on patients with diabetes. The results will provide a comprehensive evaluation of the physiological effects of exercise, and reveal the role of the microbiota-gut-brain axis in exercise-induced metabolic benefits to diabetes.

CLINICAL TRIAL REGISTRATION

http://www.chictr.org.cn/searchproj.aspx, identifier ChiCTR2100046148.

Correlation of body composition in early pregnancy on gestational diabetes mellitus under different body weights before pregnancy

OBJECTIVE

The prediction of gestational diabetes mellitus (GDM) by body composition-related indicators in the first trimester was analyzed under different body mass index (BMI) values before pregnancy.

METHODS

This was a retrospective analysis of pregnant women who were treated, had documented data, and received regular perinatal care at the Third Affiliated Hospital of Zhengzhou University from January 1, 2021, to December 31, 2021. Women with singleton pregnancies who did not have diabetes before pregnancy were included. In the first trimester (before the 14th week of pregnancy), bioelectric impedance assessment (BIA) was used to analyze body composition-related indicators such as protein levels, mineral levels, fat volume, and the waist-hip fat ratio. The Pearman's correlation coefficient was used to evaluate the linear relationship between the continuous variables and pre-pregnancy body mass index (BMI). In the univariate body composition analysis, the association with the risk of developing GDM was included in a multivariate analysis using the relative risk and 95% confidence interval obtained from logarithmic binomial regression, and generalized linear regression was used for multivariate regression analysis. Furthermore, the area under the curve (AUC) was calculated by receiver operating characteristic (ROC) curves. The optimal cutoff value of each risk factor was calculated according to the Youden Index.

RESULTS

In a retrospective study consisting of 6698 pregnant women, we collected 1109 cases of gestational diabetes. Total body water (TBW), protein levels, mineral levels, bone mineral content (BMC), body fat mass (BFM), soft lean mass (SLM), fat-free mass (FMM), skeletal muscle mass (SMM), percent body fat (PBF), the waist-hip ratio (WHR), the visceral fat level (VFL), and the basal metabolic rate (BMR) were significantly higher in the GDM group than in the normal group (P<0.05). Under the pre-pregnancy BMI groupings, out of 4157 pregnant women with a BMI <24 kg/m², 456 (10.97%) were diagnosed with GDM, and out of 2541 pregnant women with a BMI ≥24 kg/m², 653 (25.70%) were diagnosed with GDM. In the generalized linear regression model, it was found that in all groups of pregnant women, pre-pregnancy BMI, age, gestational weight gain (GWG) in the first trimester, and weight at the time of the BIA had a certain risk for the onset of GDM. In Model 1, without adjusting for confounders, the body composition indicators were all positively correlated with the risk of GDM. In Model 3, total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM. After Model 4 was adjusted for confounders, only the waist-hip ratio was positively associated with GDM onset. Among pregnant women with a pre-pregnancy BMI <24 kg/m², the body composition-related indicators in Model 2 were all related to the onset of GDM. In Model 3, total body water, soft lean mass, fat-free mass, and the basal metabolic rate were negatively correlated with GDM onset. In the body composition analysis of among women with a pre-pregnancy BMI ≥ 24 kg/m², only Model 1 and Model 2 were found to show positive associations with GDM onset. In the prediction model, in the basic data of pregnant women, the area under the receiver operating characteristic curve predicted by gestational weight gain for GDM was the largest (0.795), and its cutoff value was 1.415 kg. In the body composition results, the area under the receiver operating characteristic curve of body fat mass for predicting GDM risk was larger (0.663) in all pregnant women.

CONCLUSIONS

Through this retrospective study, it was found that the body composition-related indicators were independently associated with the onset of GDM in both the pre-pregnancy BMI <24 kg/m² and pre-pregnancy BMI ≥24 kg/m² groups. Body fat mass, the visceral fat level, and the waist-hip ratio had a higher correlation with pre-pregnancy BMI. Total body water, protein levels, mineral levels, bone mineral content, soft lean mass, fat-free mass, skeletal muscle mass, and the basal metabolic rate were protective factors for GDM after adjusting for some confounders. In all pregnant women, the waist-hip ratio was found to be up to 4.562 times the risk of GDM development, and gestational weight gain had the best predictive power for GDM. Gestational weight gain in early pregnancy, body fat mass, and the waist-hip ratio can assess the risk of GDM in pregnant women, which can allow clinicians to predict the occurrence of GDM in pregnant women as early as possible and implement interventions to reduce adverse perinatal outcomes.

The Relationship Between Fat-Free Mass and Glucose Metabolism in Children and Adolescents: A Systematic Review and Meta-Analysis

PURPOSE

To assess the relationship between fat-free mass (FFM) and glucose metabolism in children 0-18 years of age.

METHODS

We performed a systematic review of the literature on Medline/PubMed, SinoMed, Embase, and the Cochrane Library using the PRISMA 2020 guidelines to 12 October 2021; this encompassed observational studies in which the relationship between FFM and glucose metabolism was assessed. Correlation coefficient (r), regression coefficient (β), and odds ratio (OR) values in the studies were extracted and recorded as the primary data. "Agency for Healthcare Research and Quality" quality-assessment forms recommended for cross-sectional/prevalence studies were applied to evaluate the quality of the selected studies, and we executed R software to combine the pooled data.

RESULTS

We included eight studies comprising 13,282 individuals, five of which involved the assessment of the relationship between FFM and blood glucose, and four on the relationship between FFM and insulin resistance (IR). Our results showed that FFM was significantly associated with fasting plasma insulin levels (r = 0.34, 95% CI: 0.30-0.39, P < 0.001). Due to high heterogeneity or insufficient quantity of data, the studies of the relationship between FFM and fasting plasma glucose, HOMA-IR, or HbA1c were not congruent, and were therefore not suitable for meta-analysis.

CONCLUSION

Our results indicated that FFM was significantly associated with fasting plasma insulin levels. As far as we have determined, this is the first-ever systematic review and meta-analysis of the associations between FFM and glucose metabolism in children and adolescents; and our results thus provide novel information to fill a gap in the literature in this area.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020150320, PROSPERO CRD42020150320.

Changes in creatinine-to-cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: The China Health and Retirement Longitudinal Study

BACKGROUND

Creatinine-to-cystatin C ratio has attracted substantial interest as a measure to reflect health well-being, but no studies have assessed whether its longitudinal changes are associated with risk of diabetes. We aimed to examine their association, along with the exploration of the relationship of such changes with cardiometabolic control in middle-aged and older adults.

METHODS

We included a total of 3278 participants aged ≥45 years who provided measurements of creatinine and cystatin C at baseline and 4 years later from the China Health and Retirement Longitudinal Study. Diabetes was diagnosed based on glucose, hemoglobin A1c (HbA1c), medical history, or use of antidiabetic mediations. Odds ratio (OR) and 95% confidence interval (CI) were obtained using logistic regression analyses.

RESULTS

After 4-year follow-up, 272 participants developed diabetes. Larger increases in creatinine-to-cystatin C ratio were associated with lower risk of diabetes. The multivariable-adjusted OR for diabetes per 1 SD increase in creatinine-to-cystatin C ratio was 0.84 (95% CI 0.72-0.98). Compared with participants showing decreases in creatinine-to-cystatin C ratio but increases in body mass index (BMI), those experiencing increases in creatinine-to-cystatin C ratio and decreases in BMI had the largest risk reduction (multivariable-adjusted OR 0.52). Changes in creatinine-to-cystatin C ratio showed inverse correlation with blood pressure, HbA1c, lipids, and C-reactive protein at the 4-year follow-up. Moreover, they also correlated inversely with changes in HbA1c and C-reactive protein (all P ≤ 0.004).

CONCLUSIONS

Increases in creatinine-to-cystatin C ratio led to reduced risk of diabetes and may benefit cardiometabolic control.

Total and regional fat-to-muscle mass ratio measured by bioelectrical impedance and risk of incident type 2 diabetes

BACKGROUND

The fat-to-muscle mass ratio (FMR) might be an indicator to assess type 2 diabetes risk independent of general obesity. However, no longitudinal studies have explored the extent to which total and regional FMRs may confer risks. We aimed to measure the sex-specific associations between FMRs of the arm, leg, trunk and whole body and incident type 2 diabetes.

METHODS

A total of 464 817 participants (207 286 men and 257 531 women, mean age 56.5 ± 8.2 and 56.2 ± 8.0 years old, respectively) free of diabetes at baseline were included in this prospective cohort study with UK Biobank data. Fat mass and muscle mass were estimated using a bioelectrical impedance assessment device (Tanita BC 418MA). FMR was calculated as fat mass divided by muscle mass in corresponding body parts (total body, arm, leg and trunk). Cox proportional hazard models were used to estimate the aforementioned associations among men and women. Interaction analyses were performed between FMRs and body mass index (BMI) categories (BMI < 25 kg/m² and BMI ≥ 25 kg/m² ).

RESULTS

Over the median 11.0 years (5 057 534 person-years) of follow-up, we documented 11 618 cases of type 2 diabetes. There was a significantly positive association between total and regional FMR and incident type 2 diabetes, even after adjusting for BMI and other covariates. Compared with other body parts, FMRs of the whole body and leg showed the strongest relationship among men and women, respectively (hazard ratio per 1 SD, 95% confidence interval: 1.67, 1.55-1.80; 1.45, 1.39-1.53). A significant interaction (P for interaction < 0.001) between BMI category and FMRs of different body parts was observed. In the stratified analysis by BMI category and tertiles of FMRs, overweight/obese individuals with a high FMR tertile tended to have the highest hazard ratio, ranging from 5.91 to 7.94 in whole body and regional areas.

CONCLUSIONS

In this large prospective study, higher total and regional FMRs were associated with a higher risk of developing type 2 diabetes, independent of BMI. This association was markedly strengthened in participants with BMI ≥ 25 kg/m² .

Relative associations of abdominal and thigh compositions with cardiometabolic diseases in African Caribbean men

BACKGROUND

Regional body compositions are differentially associated with cardiometabolic risk factors. Simultaneous inclusion of both upper and lower body composition predictors in models is not often done, and studies which do include both measures (1) tend to exclude some tissue(s) of potential metabolic relevance, and (2) have used study populations with underrepresentation of individuals with African ancestries. Further, most body composition analyses do not employ compositional data analytic approaches, which may result in spurious associations.

OBJECTIVE

The objective of this analysis was to assess associations of abdominal and thigh adipose (AT) and muscle tissues with hypertension and type 2 diabetes using compositional data analytic methods.

RESEARCH DESIGN AND METHODS

This cross-sectional analysis included 610 African Caribbean men (median age: 62 years; mean BMI: 27.8 kg/m2). Abdominal (three components: subcutaneous [ASAT] and visceral [VAT] AT, 'other' abdominal tissue) and mid-thigh (four components: subcutaneous and intermuscular AT, muscle, bone) compositions were measured by computed tomography; additive log ratio transformations were applied to each composition. Regression models were used to simultaneously assess associations of abdominal and thigh component ratios with continuous risk factors (blood pressures, fasting glucose and insulin, HOMA-IR) and disease categories.

RESULTS

A two-fold increase in ASAT:'Other' ratio was associated with higher continuous risk factors and with odds of being in a higher hypertension (OR: 1.77, 95%CI: 1.10-2.84) or diabetes (OR: 1.81, 95%CI: 1.06-3.10) category. A two-fold increased VAT ratio was only associated with higher log-insulin and log-HOMA-IR (β = 0.10, p < 0.05 for both), while a two-fold increased thigh muscle:bone ratio was associated with a lower diabetes category (OR: 0.37, 95%CI: 0.14-1.01).

CONCLUSIONS

These findings support ASAT as a significant driver of cardiometabolic disease in African Ancestry populations, independent of other abdominal and thigh tissues.

Involvement of the fecal amino acid profile in a clinical and anthropometric study of Mexican patients with insulin resistance and type 2 diabetes mellitus

The amino acids synthesized by the intestinal microbiota have been correlated with metabolic diseases, such as type 2 diabetes mellitus and insulin resistance; both are high incidence conditions in Mexico. However, the knowledge of the relationship of fecal amino acids with the development of both diseases in the Mexican population is scarce. The clinical study was descriptive; the study was carried out in the Antiguo Civil Hospital of Guadalajara. Samples were taken from a total of 48 participants with insulin resistance, diabetes, and a control group (n = 16 each). Anthropometric and biochemical measures were evaluated. HPLC carried out the quantification of fecal amino acids. A strong correlation between alanine and HOMA-IR (r = 0.5416) was found and between phenylalanine and HOMA-IR (r = 0.4258). Other interesting correlations were between alanine and glucose (r = 0.5854) and isoleucine and glucose (r = 0.5008). The diabetic group and the insulin-resistant group had increased fecal values of valine and isoleucine (branched-chain amino acids), which were positively correlated with the progression of both conditions. Likewise, alanine and phenylalanine can help predict the development of the disease in the Mexican population. Registry number: 037/19.

Associations Between Glucose Tolerance, Insulin Secretion, Muscle and Fat Mass in Cystic Fibrosis

Background:

A frequent comorbidity in cystic fibrosis (CF) is CF related diabetes (CFRD) caused by a gradual decline in insulin secretion. The reduction in the anabolic hormone, insulin, might explain the weight loss that precedes onset of CFRD. We investigated the association between muscle and fat mass in relation to glucose tolerance and insulin function.

Methods:

In a cross-sectional study with CF patients (⩾18 years), we conducted an oral glucose tolerance test and dual energy X-ray absorptiometry scan (DXA). Based on plasma glucose, glucose tolerance was defined as normal (NGT): 1-hour <11.1 mmol/L and 2-hour <7.8 mmol/L, impaired (IGT): 2-hour ⩾7.8 and <11.1 mmol/L or CFRD: 2-hour ⩾11.1 mmol/L. Insulin resistance (HOMA-IR) was derived from fasting levels of plasma glucose and plasma insulin, and fat-free and fat mass index (kg/m²) from DXA. Associations were evaluated using linear regression models adjusted for age, sex, and pancreas insufficiency.

Results:

Among 79 CF patients with exocrine pancreas insufficiency, impairment of glucose tolerance corresponded to reduced insulin secretion. In the IGT group the fat-free mass index (FFMI) was 1.2 kg/m² (95% CI: [−2.3, −0.03] kg/m², P = .044) lower compared to the NGT group. FFMI increased insignificantly by 0.4 kg/m² (95% CI: [−0.6, 1.5] kg/m², P = .422) among the insulin-treated CFRD group compared to IGT. Fat mass index (FMI) was not different between groups but tended to decrease with glucose tolerance impairment. For each 100 pmol/L increase in fasting insulin FFMI increased by 1.77 kg/m² (95% CI: [0.21, 3.33] kg/m²/pmol/L/100) and FMI increased by 6.15 kg/m² (95% CI: [3.87, 8.44] kg/m²/pmol/L/100). In multivariate analyses, HOMA-IR was positively associated with FFMI (β = 0.5 kg/m²/HOMA-IR, 95% CI: [0.08, 0.92] kg/m²/HOMA-IR, P = .021) and FMI (β = 1.5 kg/m²/HOMA-IR, 95% CI: [0.87, 2.15] kg/m²/HOMA-IR, P < .001).

Conclusions:

Muscle mass was significantly lower among participants with impaired glucose tolerance (IGT), while muscle mass was normalized among those treated with insulin.

Catch-Up Growth in Children Born Small for Gestational Age Related to Body Composition and Metabolic Risk at Six Years of Age in the UK

OBJECTIVES

To determine differences in body composition and glucose metabolism according to childhood growth outcomes in a population-based sample of children born small for gestational age (SGA).

METHODS

A single-centre study of 259 children born SGA identified through hospital records and contacted when aged 4-7 years. Questionnaire data on pre/perinatal history and growth parameters during childhood was collected from the parents, and in a subgroup of 150 children face-to-face assessments were performed, including anthropometric parameters, lean and fat mass, blood pressure, fasting glucose, and C-peptide.

RESULTS

Based on the questionnaires, few children had formal clinic follow-up of growth, but 7% of the cohort showed a height and weight of <-2SDS during childhood, and only 2 children met the criteria for growth hormone therapy. Out of the 150 children assessed at a mean age of 6.1 ± 0.8 years, 122 (81%) showed a catch-up growth in weight. Compared to those without weight catch-up, these children had a higher fat mass index (3.13 ± 1.36 vs. 2.56 ± 0.91 kg/m2, p = 0.04), trunk-to-limb fat mass ratio (0.63 ± 0.14 vs. 0.56 ± 0.08, p = 0.002), systolic blood pressure SDS (0.09 ± 0.71 vs. -0.32 ± 0.63, p = 0.008), fasting glucose (4.5 ± 0.5 vs. 4.3 ± 0.5 mmol/L, p = 0.03), and C-peptide (306 ± 116 vs. 256 ± 112 pmol/L, p = 0.08). Among children with weight catch-up growth, those with less height gain had a lower limb lean mass index (4.25 ± 0.48 vs. 4.48 ± 0.56 kg/m2, p = 0.02) and fat mass index (1.57 ± 0.59 vs. 1.83 ± 0.77 kg/m2, p = 0.04).

CONCLUSIONS

Within this population-based sample of SGA children, catch-up growth in weight was associated with higher abdominal fat mass, blood pressure and glycemia; furthermore, in these children, less height gain was associated with reduced limb lean and fat mass.

ADAS-viewer: web-based application for integrative analysis of multi-omics data in Alzheimer's disease

Alzheimer's disease (AD) is a neurodegenerative disorder and is represented by complicated biological mechanisms and complexity of brain tissue. Our understanding of the complicated molecular architecture that contributes to AD progression benefits from performing comprehensive and systemic investigations with multi-layered molecular and biological data from different brain regions. Since recently different independent studies generated various omics data in different brain regions of AD patients, multi-omics data integration can be a useful resource for better comprehensive understanding of AD. Here we present a web platform, ADAS-viewer, that provides researchers with the ability to comprehensively investigate and visualize multi-omics data from multiple brain regions of AD patients. ADAS-viewer offers means to identify functional changes in transcript and exon expression (i.e., alternative splicing) along with associated genetic or epigenetic regulatory effects. Specifically, it integrates genomic, transcriptomic, methylation, and miRNA data collected from seven different brain regions (cerebellum, temporal cortex, dorsolateral prefrontal cortex, frontal pole, inferior frontal gyrus, parahippocampal gyrus, and superior temporal gyrus) across three independent cohort datasets. ADAS-viewer is particularly useful as a web-based application for analyzing and visualizing multi-omics data across multiple brain regions at both transcript and exon level, allowing the identification of candidate biomarkers of Alzheimer's disease.

Skeletal Muscle and Metabolic Health: How Do We Increase Muscle Mass and Function in People with Type 2 Diabetes?

BACKGROUND

Whilst skeletal muscles' primary role is allowing movement, it has important metabolic roles, including in glycemic control. Indeed, evidence indicates that low muscle mass and function are associated with an increased risk of type 2 diabetes, highlighting its importance in the development of metabolic disease.

METHODS

In this mini-review, we detail the evidence highlighting the importance of muscle in type 2 diabetes and the efficacy of resistance exercise in improving glycemic control alongside our approach to increase uptake of such exercise in people with type 2 diabetes. This summary is based in the authors' knowledge of the filed supplemented by a Pubmed search using the terms "muscle," "glycemic control," "HbA1c," "type 2 diabetes," and "resistance exercise."

RESULTS

The main strategy to increases muscle mass is to perform resistance exercise and, although the quality of evidence is low, such exercise appears effective in reducing Glycated Haemoglobin (HbA1c) in people with type 2 diabetes. However, to increase participation we need to improve our understanding of barriers and facilitators to such exercise. Current data indicate that barriers are similar to those reported for aerobic exercise, with additional resistance exercise specific barriers of looking to muscular, increase risk of cardiovascular event, having access to specialized equipment and knowledge of how to use it.

CONCLUSIONS

The development of simple resistance exercises that can be performed anywhere, that use little or no equipment and are effective in reducing HbA1c will be, in our opinion, key to increasing the number of people with type 2 diabetes performing resistance exercise.

Association of the triglyceride and glucose index with low muscle mass: KNHANES 2008-2011

The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance. We evaluated the association of the TyG index with low muscle mass using a nationwide population-based representative data. This is a cross-sectional study that included 9477 participants aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey between 2008 and 2011. The TyG index was calculated as ln[triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. Dual-energy X-ray absorptiometry was used to measure appendicular lean mass (ALM). Low muscle mass was defined an ALM/weight of 2 standard deviations (SD) below of young participants. The overall prevalence of low muscle mass was 4.7%. The prevalence of low muscle mass increased linearly with the quartiles of the TyG index, 2.5%, 4.2%, 5.6%, and 6.7% in Q1–Q4, respectively. The TyG index was negatively associated with ALM/weight both in men (r = − 0.302) and women (r = − 0.230). The odds ratio (OR) for low muscle mass was 2.08 in the highest quartile compared to the lowest quartile. High TyG index was associated with an increased risk of low muscle mass (OR for 1SD increase: 1.13). Increased TyG index was associated with the risk of low muscle mass independent of confounding factors.

Relationship between low skeletal muscle mass, sarcopenic obesity and left ventricular diastolic dysfunction in Korean adults

BACKGROUND

Heart failure with preserved ejection fraction is an emerging global health issue attributed to an ageing population. However, the association between low skeletal muscle mass, sarcopenic obesity, and left ventricular diastolic dysfunction remains unclear. In the current study, we aimed to investigate the relationship between low skeletal muscle mass, sarcopenic obesity, and diastolic dysfunction in a large cohort of Korean adults.

METHODS

We conducted a cross-sectional study of 31 258 subjects who underwent health examinations at Samsung Medical Centre's Health Promotion Centre in Seoul, Republic of Korea. Relative skeletal muscle mass was calculated using the skeletal muscle mass index [SMI (%) = appendicular skeletal muscle mass (kg)/body weight (kg) × 100], which was estimated by bioelectrical impedance analysis. Cardiac structure and function were evaluated by echocardiography.

RESULTS

Amongst the 31 258 subjects, 3058 (9.78%) were determined to have diastolic dysfunction. The odds ratio (OR) of diastolic dysfunction was 1.56 [95% confidence interval (CI): 1.31-1.85; p for trend <0.001] for the lowest SMI tertile relative to the highest SMI tertile following multivariable adjustment. Furthermore, the risk of diastolic dysfunction was much higher in the sarcopenic obesity (OR: 1.70, 95% CI: 1.44-1.99), followed by in the obesity-only (OR: 1.40, 95% CI: 1.21-1.62), and sarcopenia-only (OR: 1.32, 95% CI: 1.08-1.61) when compared with the nonobese, nonsarcopenic group. These results remained consistent amongst the elderly (age ≥ 65 years).

CONCLUSIONS

Our findings demonstrate that lower skeletal muscle mass and sarcopenic obesity are strongly associated with diastolic dysfunction in middle-aged and older adults.

Joint impact of muscle mass and waist circumference on type 2 diabetes in Japanese middle-aged adults: The Circulatory Risk in Communities Study (CIRCS)

BACKGROUND

Although evidence about skeletal muscle mass loss and type 2 diabetes risk has accumulated, little information is available on the combined effect of skeletal muscle mass and abdominal obesity on type 2 diabetes. We examined whether skeletal muscle mass and abdominal obesity were synergistically associated with the prevalence of type 2 diabetes.

METHODS

Skeletal muscle mass and waist circumference (WC) were measured in 1515 Japanese aged 40 to 69 years. Relative muscle mass was calculated as percentage of total skeletal muscle mass in body weight (SMM%). Type 2 diabetes was identified as fasting serum glucose ≥7.0 mmol/L (126 mg/dL), nonfasting serum glucose ≥11.1 mmol/L (200 mg/dL), glycosylated hemoglobin ≥ 6.5%, and/or diabetes medication use.

RESULTS

The multivariable-adjusted odds ratio (OR) of prevalent diabetes from the lowest to the third quartile of SMM% compared to the highest quartile gradually increased in both sexes. The association between a high WC and prevalent diabetes was similar. The multivariable-adjusted OR (95% confidence intervals) for the prevalence of type 2 diabetes in the low skeletal muscle mass/high WC group was 3.19 (1.78-5.71) for men and 4.46 (2.09-9.51) for women compared with the high skeletal muscle mass/low WC group. The relative excess risk due to interaction was 2.2 (0.5-3.9) in men and 2.8 (0.2-5.3) in women for an excess burden of type 2 diabetes for low skeletal muscle mass and high WC.

CONCLUSIONS

Low skeletal muscle mass and abdominal obesity were synergistically associated with presence of type 2 diabetes.

Dose-response associations between serum creatinine and type 2 diabetes mellitus risk: A Chinese cohort study and meta-analysis of cohort studies

BACKGROUND

This study aims to investigate the association between serum creatinine and risk of type 2 diabetes mellitus (T2DM) based on a cohort analysis and meta-analysis of cohort studies.

METHODS

We enrolled 41 439 participants aged ≥18 years without T2DM at baseline, who had ≥2 health examinations based on an ongoing prospective cohort in Beijing. Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and 95% CIs. For the meta-analysis, cohort studies reporting risk estimates for the serum creatinine-T2DM association were included. A random-effects model was used to calculate summary relative risks (RRs) and restricted cubic splines to model the dose-response association.

RESULTS

During a mean follow-up of 3.54 years, 1867 developed T2DM. Low serum creatinine was associated with increased risk of T2DM; adjusted HRs (95% CIs) across sex-specific quartiles were 1.45 (1.24, 1.71), 1.19 (1.02, 1.39), 1.07 (0.92, 1.24), and 1.00 (reference). The association was significant for both sexes and individuals with overweight or obesity. In the meta-analysis of six cohort studies (including the current study) involving 115 767 participants and 5370 T2DM events, the pooled RR was 1.61 (95% CI 1.35, 1.92), comparing the lowest with the highest category of serum creatinine. We found a linear association between serum creatinine and T2DM risk (P_nonlinearity = .082) and an increased risk of T2DM with each 0.1-mg/dL decrease in serum creatinine (RR = 1.07; 95% CI 1.04, 1.09).

CONCLUSIONS

The cohort study and meta-analysis provide further evidence supporting the negative association between serum creatinine and T2DM risk in a linear dose-response pattern.

Caloric restriction in heart failure: A systematic review

BACKGROUND AND AIMS

Nutrition exerts a determinant role in maintaining cardiac function, regulating insulin and mitochondrial efficiency, that are essential to support energy production for contractility. In patients with heart failure (HF), myocardial tissue efficiency is reduced because of decreased mitochondrial oxidative capacity. In HF conditions, cardiomyocytes shift toward glucose and a reduction in fatty acid utilization. Calorie restriction induces weight loss in obese patients and can be beneficial in some HF patients, although this has generated some controversy. This study aims to evaluate the impact of the CR diet on myocardial efficiency in HF patients.

METHODS

On Pubmed and Embase, articles related to the keywords: "chronic heart failure" with "diet," "nutrition," "insulin resistance," and "caloric restriction" have been searched, Studies, including exercise or food supplementation, were excluded.

RESULTS

The retrieved articles showed that weight loss, through the activation of insulin and various kinase pathways, regulates the efficiency of myocardial tissue. In contrast, insulin resistance represents a strong cardiovascular risk factor that reduces myocardial function.

CONCLUSION

CR diet represents the first therapy in overweight HF patients, both with preserved ejection fraction (HFpEF) and with reduced ejection fraction (HFrHF) because reducing body fat, the myocardial function increased. Insulin activity is the critical hormone that regulates mitochondrial function and cardiac efficiency. However, a severely restricted diet may represent a severe risk factor correlated with all-cause mortality, particularly in underweight HF patients. Long-term studies conducted on large populations are necessary to evaluate the effects of CR on myocardial function in HF patients.

The functional nutritional and regulatory activities of calcium supplementation from eggshell for obesity disorders management

The present study was to investigate the effective role of renewable sources of Ca⁺² from eggshell (ES) with different doses to restrict obesity disorders. Rats were classified as follows, G₁ : normal diet for 26 weeks; G₂ : high-fat diet (HFD) for 26 weeks; G₃ , G₄ , and G₅ were supplemented with HFD for 16 weeks and treated with 7.2 g Ca⁺² ES/Kg rat chow, 18 g Ca⁺² ES/Kg rat chow, and 2% diet containing fat (DCF), respectively, for the remaining 10 weeks. Results revealed a significant effect of the low dose of Ca⁺² supplement in form of ES than high dose and 2% DCF; on basis of anthropometric parameters, lipid, leptin, adiponectin, thyroid hormones, Ca⁺² , 25-hydroxyl vitamin-D, and oxidative and inflammatory parameters were regulated. Results were confirmed with the histopathological study. Therefore, it was concluded that Ca⁺² supplementation can be used as a beneficial source for obesity management with anticholesterol actions. PRACTICAL APPLICATIONS: Obesity represented public health hazards. The eggshell is one of the waste products that contain a high percentage of Ca⁺² . The current data exposed using a low dose of ES as a new source of Ca⁺² supplement for treatment of HFD rats leads to significant enhancement of lipid profiles, liver enzymes, kidney functions, leptin, adiponectin, Ca⁺² , 25(OH)-D, TSH, fT_4, and PTH levels. Also, there was a reduction in weight gain, Bwt, BMI, BG, insulin, and HOMA-IR. Moreover, the oxidant-pro-oxidant system was improved in both hepatic and adipose tissues where NO and TBARS concentrations were diminished, and SOD specific activity was elevated. Additionally, TNF-α and ADAM17 expression were downregulated. Hence, it was concluded that there was good evidence that diets supplemented with ES were associated with the reduction of obesity complications especially regulating fat processing and storage in the body.

Association between the Thigh Muscle and Insulin Resistance According to Body Mass Index in Middle-Aged Korean Adults

BACKGROUND

We examined the associations between thigh muscle area (TMA) and insulin resistance (IR) according to body mass index (BMI) in middle-aged Korean general population.

METHODS

TMA was measured using quantitative computed tomography and corrected by body weight (TMA/Wt) in 1,263 men, 788 premenopausal women, and 1,476 postmenopausal women all aged 30 to 64 years. The tertiles of TMA/Wt were calculated separately for men and for premenopausal and postmenopausal women. Homeostatic model assessment for insulin resistance (HOMA-IR) was performed using fasting blood glucose and insulin levels, and increased IR was defined according to sex-specific, top quartiles of HOMA-IR. Associations between the TMA/Wt tertiles and increased IR according to the BMI categories (<25 and ≥25 kg/m²) were assessed using multivariable logistic regression analysis.

RESULTS

In men with higher BMIs, but not in those with lower BMIs, the presence of an increased IR had significantly higher odds ratios in the lower TMA/Wt tertiles, even after adjustment for visceral fat area. However, in premenopausal and postmenopausal women, there was no significant inverse association between TMA/Wt tertiles and increased IR, regardless of BMI category.

CONCLUSION

Our findings suggest that the thigh muscle is inversely associated with IR in men, particularly in those with higher BMIs.

An update on nutrient modulation in the management of disease-induced muscle wasting: evidence from human studies

PURPOSE OF REVIEW

Skeletal muscle has many essential roles in maintaining human health, not only being crucial for locomotion, but further as a metabolically important organ. Muscle wasting in disease (cachexia) is highly prevalent, associated with poor clinical outcomes and is not fully reversible with nutritional interventions. Understanding proteostasis in diseased states is of great importance to design novel, effective nutritional/nutraceutical strategies aimed at alleviating muscle wasting. In this review, we will provide an update on muscle kinetics in disease and the effects of nutritional interventions.

RECENT FINDINGS

Whole body and skeletal muscle kinetics are commonly shown to be imbalanced in disease, promoting overall catabolism that underlies the development of cachexia. However, recent advancements in defining the effectiveness of nutritional interventions on muscle anabolism are clouded by heterogenous patient populations and a lack of direct incorporation stable isotope techniques. Current recommendations are focused on combating malnutrition, with increased protein intake (high in EAA) demonstrating promise.

SUMMARY

Recent progress in understanding catabolic states in cachexia across disease is minimal. Further, studies investigating muscle-specific protein turnover along with nutritional interventions are scarce. As such, there is a significant requirement for strong RCT's investigating both acute and chronic nutritional interventions and their impact on skeletal muscle in individual disease states.

Asian Indians With Prediabetes Have Similar Skeletal Muscle Mass and Function to Those With Type 2 Diabetes

Background: Type 2 Diabetes (T2D) is a major concern among Asian Indians, not least because many develop T2D at despite having a normal BMI (body mass index), and with relatively low body fat. Asian Indians are also generally considered to have relatively low skeletal muscle mass and strength, this has not been explored in the context of T2D.

Aim: The present study aimed to compare skeletal muscle mass, function and contractile quality (strength/mass) between healthy controls, those with prediabetes (PD) as well as T2D middle-aged non-obese Asian Indians.

Methods: Adult males between the age of 20–50 years, consisting of healthy controls (n = 44), PD (n = 125) and T2D (n = 55) were studied. Skeletal muscle mass was measured using Dual X-ray Absorptiometry (DXA). Isometric and dynamic muscle function was measured using an isokinetic dynamometer (at 0, 60, 120, 180 degree/s). Muscle contractile quality was derived by dividing the peak muscle torque with the respective LMM (lower limb muscle mass). Fasting blood glucose (FBG) and insulin were used to derive insulin resistance (HOMA-IR).

Results: The control group was on average 10 years younger than the other two groups (p < 0.01). The LMM was similar across the three study groups. However, the age-adjusted mean muscle torque was significantly lower in both absolute and normalized isometric and isokinetic strength in PD and T2D groups compared to controls (p ≤ 0.01), with the difference persisting even after adjusting for age and other covariates. However, there was no difference in muscle strength and contractile quality between the PD and T2D study groups.

Conclusions: Muscle strength and contractile quality would appear to be sensitive and early indices of the trajectory toward diabetes in Asian Indians and more so than skeletal muscle mass. It is thus important to recognize the importance of functional measurements among this population when considering the role of muscle in diabetes. The data also would suggest that specific muscle conditioning (e.g., resistance training) might have efficacy in improving function as well as muscle mass, and thus aiding in the prevention of the trajectory toward the development of T2D.

Berberine chloride ameliorated PI3K/Akt-p/SIRT-1/PTEN signaling pathway in insulin resistance syndrome induced in rats

The liver is the main organ involved in lipid metabolism process and it helps in drug detoxification. Insulin resistance is considered one of risk reasons which lead to several metabolic diseases. Currently, berberine (BER) occupies a huge challenge against multiple diseases with no toxic effect. The present work was aimed to identify, does BER-chloride has a poisonous influence on the liver? and investigating the outcome of BER-chloride on PI3K/Akt-p/SIRT-1/PTEN pathway during insulin resistance syndrome. The insulin resistance model was achieved in experimental female rats via high-fat diet (HFD). Glucose, insulin, lipid profiles, and hepatic oxidative stress parameters were assessed. PI3K, AKt-p, SIRT-1, and PTEN levels in hepatic tissue were determined at genome and protein levels. Further adiponectin concentration was performed in serum, hepatic, and white adipose tissues. Molecular study of fold alteration in insulin, insulin receptor, and retinol binding protein-4 (RBP4) in liver was done. PRACTICAL APPLICATIONS: Obesity syndrome causes multiple obstacles in modern years. The current results revealed elevation the body weight of rats, plasma glucose, homeostatic model assessment, glycated hemoglobin, insulin, and lipid profiles concentrations in a group of rats, which nourished HFD for 8 weeks and this rise, was diminished after 2 weeks from BER-chloride administration. Further, BER-chloride improved transaminases enzymes, pro-oxidant, and antioxidant defense system, PI3K, AKt-p, SIRT-1, and PTEN in the liver, with downregulation of hepatic RBP4. Hence, these data provide a crucial message that BER-chloride enhanced both hepatic function and insulin signaling pathways that might be of therapeutic importance to insulin resistance with no harmful effect on the liver. BER-chloride is predicted to be a drug of choice for obesity complications cure.