Evaluation of Stress and Associated Biochemical Changes in Patients with Type 2 Diabetes Mellitus and Obesity

PURPOSE

Type 2 diabetes mellitus (T2DM), a metabolic disorder, remains associated with a physiological impairment affecting large populations worldwide. Onset of T2DM is multifactorial where obesity and abnormal basal metabolic rate are considered most critical. Of people diagnosed with T2DM, about 80% are also obese. It is also reported that obese individuals have an increased odds of developing depression, whereas T2DM is estimated to increase the incidence by two-fold. The preponderance of research data demonstrates that T2DM alters the serum level of cortisol and adiponectin which are known to be associated with neuronal physiology. The study explored, how a metabolic disorder like T2DM is linked with the altered plasma level of cortisol and adiponectin, the risk factors for stress and depression.

PATIENTS AND METHODS

A cross-sectional population study was conducted in T2DM patients using a bimodal approach. First approach used questionnaires, (1) Patient Health Questionnaire (PHQ-9) and (2) Stress Coping Inventory Questionnaire (SCQ) to assess signs and symptoms of depression and stress, respectively, in T2DM patients. In the second approach, robust biochemical analysis was conducted for serum adiponectin and cortisol levels.

RESULTS

An association of T2DM in stress and depression was evaluated in 158 subjects (105 T2DM obese patients and 53 healthy controls). A lower PHQ-9 score and adiponectin levels were seen in T2DM obese patients compared to healthy controls (p<0.05). Further, results also depicted a lower adiponectin levels in T2DM obese patients with depression compared to T2DM obese patients without depression (p<0.05). The study did not find a significant difference in cortisol serum levels among the T2DM and control groups. However, a higher level of serum cortisol was reported in T2DM obese patients with depression over those T2DM obese patients who lacked depression (p<0.05).

CONCLUSION

The findings suggest that T2DM obese patients might have a higher risk of developing stress and depression. Further, biochemical parameters, adiponectin and cortisol, might be the potential biomarkers for T2DM and may help in early diagnosis of these comorbid conditions.

The effect of exercise on lipid profiles and inflammatory markers in lean male adolescents: a prospective interventional study

BACKGROUND

Physical activity improves body composition and inflammatory markers in obese individuals, but little is known about the nonobese population.

OBJECTIVE

The aim of this study was to investigate associations between exercise and inflammatory cytokines in lean male adolescents in Taiwan.

METHODS

This interventional study enrolled a total of 79 normal body weight male adolescents [mean age, 16.8 (1.0) years] from the Army Academy of Taiwan. Body composition and inflammatory markers were measured at baseline and upon completion of a 12-week exercise intervention program.

RESULTS

Subjects' postintervention anthropometric measures, including waist circumference [74.6 (5.2)→72.6 (5.2) cm], hip circumference [92.3 (4.1)→89.9 (5.0) cm], body fat mass [10.2 (3.2)→8.2 (3.2) kg], and body fat percentage [15.8% (4.2)→12.6 (4.5)%] declined significantly compared to preintervention (all P<0.001), as did systolic blood pressure (P=0.002) and mean blood pressure (P = 0.020). Postintervention body height and free fat mass increased significantly (both P<0.001). Subjects' postintervention lipids including total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides increased significantly (all P<0.001). Inflammatory markers including adiponectin [14.32 (6.68)→31.31 (30.53) μg/mL, P<0.001], interleukin 6 [2.15 (4.81)→2.86 (6.37) pg/mL, P=0.005], and C-reactive protein [1.00 (2.57)→2.30 (4.17) μg/mL, P<0.001] increased significantly postintervention, but not leptin.

CONCLUSIONS

Exercise training significantly improves body composition and anti-inflammatory adiponectin levels in lean male adolescents.

Abnormal adipose tissue distribution with unfavorable metabolic profile in five children following hematopoietic stem cell transplantation: a new etiology for acquired partial lipodystrophy

We report five consecutive patients who underwent hematopoietic stem cell transplantation (HSCT) to treat leukemia or neuroblastoma early in their lives and later manifested abnormal patterns of adipose tissue distribution. Lipoatrophy was remarkable in the gluteal regions and extremities, whereas subcutaneous fat was preserved in the cheeks, neck, and abdomen. In addition, visceral fat deposition, fatty changes in the liver, and metabolic derangements such as insulin resistance and hypertriglyceridemia were evident. These features resemble Dunnigan-type familial partial lipodystrophy, which is a rare condition caused by LMNA gene mutation. These patients shared a common medical history involving HSCT, including conditioning with total body irradiation (TBI). They also received intensive chemotherapy because of multiple metastases (n = 3), relapse (n = 3), and repetitive HSCT (n = 3). We propose HSCT as a new etiology for acquired partial lipodystrophy and recommend that patients who undergo HSCT with TBI and intensive chemotherapy early in their lives must receive careful observation for the possible development of lipodystrophy and metabolic complications.

Abnormal adipose tissue distribution with unfavorable metabolic profile in five children following hematopoietic stem cell transplantation: a new etiology for acquired partial lipodystrophy

We report five consecutive patients who underwent hematopoietic stem cell transplantation (HSCT) to treat leukemia or neuroblastoma early in their lives and later manifested abnormal patterns of adipose tissue distribution. Lipoatrophy was remarkable in the gluteal regions and extremities, whereas subcutaneous fat was preserved in the cheeks, neck, and abdomen. In addition, visceral fat deposition, fatty changes in the liver, and metabolic derangements such as insulin resistance and hypertriglyceridemia were evident. These features resemble Dunnigan-type familial partial lipodystrophy, which is a rare condition caused by LMNA gene mutation. These patients shared a common medical history involving HSCT, including conditioning with total body irradiation (TBI). They also received intensive chemotherapy because of multiple metastases (n = 3), relapse (n = 3), and repetitive HSCT (n = 3). We propose HSCT as a new etiology for acquired partial lipodystrophy and recommend that patients who undergo HSCT with TBI and intensive chemotherapy early in their lives must receive careful observation for the possible development of lipodystrophy and metabolic complications.

The relationship between a Mediterranean diet and circulating adiponectin levels is influenced by cigarette smoking

AIM

Adherence to a Mediterranean diet has been shown to lower the risk of developing several chronic diseases. The ability to augment circulating adiponectin levels is proposed as an underlying mechanism mediating the beneficial effects of this diet. We aimed to examine whether the positive relationship between the Mediterranean diet and adiponectin is altered by cigarette smoking, taking potential confounders into consideration.

METHODS

Plasma adiponectin levels were enzymatically measured in 45 never smokers, 61 smokers and 34 ex-smokers who adhered to a Mediterranean style diet and in 41 never smokers who did not adhere to the diet.

RESULTS

Plasma adiponectin levels increased significantly in nonsmoking diet adherents compared to nonsmoking non-diet adherents. Among the diet adherents adiponectin decreased significantly in both moderate and heavy smokers compared to never smokers and significantly increased in quitters compared to smokers. Multiple regression analysis, controlling for age, obesity, Mediterranean diet and insulin resistance revealed an independent inverse association of smoking with adiponectin. Adiponectin levels remained significant and similar in subjects stratified according to age (</>50 years), BMI (</>25 kg/m(2)) and HOMA-IR (</>1.6).

CONCLUSIONS

Despite its positive effects on adiponectin, the Mediterranean diet failed to negate the adiponectin-lowering effect of cigarette smoking, demonstrating the profound and independent capacity of cigarette smoke to negatively influence human health.