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Bohl M, Gregersen S, Zhong Y, Hebelstrup KH, Hermansen K. Beneficial glycaemic effects of high-amylose barley bread compared to wheat bread in type 2 diabetes. Eur J Clin Nutr 2024; 78:243-250. [PMID: 37940671 DOI: 10.1038/s41430-023-01364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Cereals foods with a high content of dietary fibres or amylose have potential to lower postprandial glucose levels. Optimisation of cereal foods may improve management of type 2 diabetes (T2D). METHODS We investigated the impact on 4 h postprandial glucose responses given as incremental area under curve (iAUC) of bread made of either 50% RNAi-based (genetically modified) amylose-only barley flour (AmOn) (and 50% wheat flour), 50% hulless barley flour (and 50% wheat flour) or 75% hulless barley (and 25% wheat flour) in subjects with T2D compared with 100% wheat flour bread. DESIGN Twenty adults with T2D were randomly allocated to one of four breads at four separate visits. We measured fasting and 4 h postprandial responses of glucose, insulin, glucagon, triacylglycerol (TG), free fatty acids (FFA), glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP). Mixed model ANOVA was used to examine the differences. RESULTS Bread made from 50% AmOn lowered the 4 h postprandial glucose by 34%, 27%, 23% (P < 0.05) compared with 100% wheat, 50% or 75% hulless barley, respectively. Bread made from 75% hulless barley reduced the postprandial glucose response (iAUC) by 11% (P < 0.05) compared to 100% wheat bread. Postprandial insulin responses (iAUC) were reduced for 50% AmOn compared with 100% wheat and 50% hulless barley and for 75% hulless compared to 50% hulless barley bread (P < 0.05). 4 h postprandial glucagon (tAUC) did not differ between the four bread types (P > 0.05). Lower postprandial GIP (iAUC) was observed after all barley breads compared to 100% wheat (P < 0.05), whereas no difference was seen in postprandial GLP-1. Postprandial TG and FFA (tAUC) were difficult to judge due to differences in fasting values. CONCLUSIONS Bread made by replacing wheat flour with either 50% high-amylose or 75% hulless barley flour lowered postprandial glucose responses compared to 100% wheat bread indicating a beneficial impact on glucose regulation in T2D subjects. This trial was registered at clinicaltrials.gov as NCT04646746.
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Affiliation(s)
- Mette Bohl
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, 8200, Aarhus N, Denmark.
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.
| | - Søren Gregersen
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark
| | - Yuyue Zhong
- Department of Plant and Environmental Sciences, University of Copenhagen, 1871, Frederiksberg C, Denmark
| | - Kim Henrik Hebelstrup
- Department of Agroecology, Section for Crop Genetics and Biotechnology, Aarhus University, 4200, Slagelse, Denmark
- Plantcarb Aps, 2970, Hørsholm, Denmark
| | - Kjeld Hermansen
- Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
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Christiansen CB, Jeppesen PB, Hermansen K, Gregersen S. The Impact of an 8-Week Supplementation with Fermented and Non-Fermented Aronia Berry Pulp on Cardiovascular Risk Factors in Individuals with Type 2 Diabetes. Nutrients 2023; 15:5094. [PMID: 38140354 PMCID: PMC10745664 DOI: 10.3390/nu15245094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Aronia berries contain antioxidants that may be health-promoting, e.g., demonstrated positive effects on hypertension and dyslipidaemia. There is a close link between cardiovascular diseases and hypertension and dyslipidaemia, and cardiovascular events are the leading cause of death among subjects with type 2 diabetes (T2D). Thus, we investigated the effect of an 8-week supplementation with fermented aronia extract (FAE), non-fermented aronia extract (AE), and placebo on cardiovascular risk factors. Snack bars were produced containing 34 g (37%) aronia extract, or 17 g (21%) wheat bran for placebo, as well as raisins and coconut oil. The study was randomized and blinded with a triple-crossover design. We examined the effects of aronia extracts on blood pressure, adiponectin, and high-sensitive C-reactive protein, and found no effects. After supplementation with placebo, there were significantly higher blood concentrations of total cholesterol, LDL-cholesterol, and HDL-cholesterol, with the placebo group showing significantly higher increases in total cholesterol and LDL-cholesterol than the AE group. Furthermore, we observed an increase in HDL-cholesterol in the FAE group and an increase in triglyceride in the AE group. Thus, we assume that the raisins may have increased the participants' cholesterol levels, with both AE and FAE having the potential to prevent this increase.
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Affiliation(s)
- Christine B. Christiansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
| | - Per B. Jeppesen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
| | - Kjeld Hermansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Søren Gregersen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
- Steno Diabetes Center Aarhus, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
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Christiansen CB, Jeppesen PB, Hermansen K, Gregersen S. Aronia in the Type 2 Diabetes Treatment Regimen. Nutrients 2023; 15:4188. [PMID: 37836472 PMCID: PMC10574687 DOI: 10.3390/nu15194188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Aronia melanocarpa berries are rich in antioxidants and possess a high antioxidant capacity. Aronia berries have shown potential in type 2 diabetes mellitus (T2DM) treatment, and previous studies indicate improvements in glycemia after supplementation. Unfortunately, the effectiveness of aronia berries is limited by the low bioavailability of aronia, which fermentation could potentially overcome. The objective of this study was to compare the effects of fermented or non-fermented aronia pulp with placebo in subjects with T2DM. This study was a triple-blinded, triple-crossover study with eight-week intervention periods with fermented aronia extract (FAE), non-fermented aronia extract (AE), and placebo. Extracts were incorporated in snack bars with 37% aronia (FAE or AE) or wheat bran (placebo) and 63% raisins and coconut oil. Pre- and post-treatment period, we did fasting blood samples, including hemoglobin A1c, fructosamine, insulin, glucose, glucagon-like peptide-1, glucose-dependent insulinotropic peptide (GIP) and glucagon, oral glucose tolerance tests, and anthropometric measurements. Of 36 randomized participants, 23 completed the trial. Aside from a higher increase in GIP after FAE supplementation compared to after placebo supplementation, aronia extracts had no effect. The increase in GIP levels after FAE supplementation may hold potential benefits, but the overall clinical impact remains unclear.
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Affiliation(s)
- Christine B. Christiansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
| | - Per B. Jeppesen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
| | - Kjeld Hermansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Søren Gregersen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (P.B.J.); (K.H.); (S.G.)
- Steno Diabetes Center Aarhus, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
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Sangild J, Faldborg A, Schousboe C, Fedder MDK, Christensen LP, Lausdahl AK, Arnspang EC, Gregersen S, Jakobsen HB, Knudsen UB, Fedder J. Effects of Chokeberries ( Aronia spp.) on Cytoprotective and Cardiometabolic Markers and Semen Quality in 109 Mildly Hypercholesterolemic Danish Men: A Prospective, Double-Blinded, Randomized, Crossover Trial. J Clin Med 2023; 12:jcm12010373. [PMID: 36615174 PMCID: PMC9821700 DOI: 10.3390/jcm12010373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
Background: Chokeberries (Aronia spp.) are known to exhibit both direct and indirect antioxidant properties and have been associated with beneficial effects on human health, including cardiovascular risk factors (inflammation, serum lipids, sugars, blood pressure), oxidative stress, and semen quality. This prospective, double-blinded, randomized, crossover clinical trial was conducted to elucidate the effects of Aronia supplementation on these health targets in mildly hypercholesterolemic men. Methods: The standardized Aronia supplementation comprised three wild Aronia spp. (A. arbutifolia, A prunifolia and A. melanocarpa) and the Aronia hybrid × Sorbaronia mitschurinii (standardized to 150 mg anthocyanins daily). Participants (n = 109) were healthy men with respect to all outcome targets except for the total cholesterol level (5.0−7.0 mM). Participants were randomized to supplementation with either Aronia or placebo for 90 days, followed by a wash-out period and lastly the complementary supplementation. Effects on the health parameters were compared among both the whole group of men and in subgroups according to age, body mass index (BMI), lifestyle, dietary habits, and serum glutathione levels at baseline. The study is registered in ClinicalTrials.gov.: NCT03405753. Results: Glutathione levels were significantly improved after 90 days intake of Aronia supplementation compared to placebo in the subgroup of men with a low level of glutathione at baseline (p = 0.038) and a high coffee intake (p = 0.045). A significant decrease in levels of sperm DNA fragmentation and an increase in the percentage of motile sperm were observed in men aged >40 and in men with BMI > 25. Further, these parameters were significantly improved in the dietary subgroup defined by a high level of coffee intake. Total cholesterol and low-density lipoprotein-cholesterol levels decreased significantly in men <40 years after Aronia supplementation. No statistically significant effects were observed regarding blood pressure, markers of blood sugar regulation, hemoglobin A1c, superoxide dismutase, catalase, isoprostane levels, high sensitivity C reactive protein, or other semen parameters. Conclusions: This study demonstrated a significant increase in glutathione levels and improvement of cytoprotective targets following Aronia supplementation in specific subgroups of men >40 years of age and BMI > 25 but did not demonstrate a significant effect in the overall analysis. The observed concurrent increase in glutathione levels and improvement of cytoprotective targets following Aronia supplementation in subgroups of men, suggests that the endogenous phase II antioxidant glutathione is involved in the modulation of the observed cytoprotective effects. This study is a good foundation for further investigation of these cytoprotective effects in groups with oxidative stress in a dose−response study.
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Affiliation(s)
- Julie Sangild
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
| | - Anne Faldborg
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
| | - Cecilie Schousboe
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
| | | | - Lars Porskjær Christensen
- Department of Physics, Chemistry and Pharmacy, Faculty of Science, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Astrid Komal Lausdahl
- Department of Green Technology, Faculty of Engineering, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Eva Christensen Arnspang
- Department of Green Technology, Faculty of Engineering, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Søren Gregersen
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
- Steno Diabetes Center Aarhus, DK-8200 Aarhus, Denmark
| | | | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, DK-8700 Horsens, Denmark
| | - Jens Fedder
- Centre of Andrology, Fertility Clinic, Department D, Odense University Hospital, DK-5000 Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, DK-5000 Odense, Denmark
- Correspondence:
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Christiansen CB, Mellbye FB, Hermansen K, Jeppesen PB, Gregersen S. Effects of Aronia melanocarpa on Cardiometabolic Diseases: A Systematic Review of Quasi-Design Studies and Randomized Controlled Trials. Rev Diabet Stud 2022; 18:76-92. [PMID: 35831939 PMCID: PMC10044047 DOI: 10.1900/rds.2022.18.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES: Aronia melanocarpa (Aronia) is a shrub with small berries, chokeberries. Chokeberries are claimed to possess health benefits due to a high content of polyphenols. Aronia is known to be extremely antioxidant; however, evidence for its health benefits is not established.
This review gives an overview of the impact of Aronia on cardiometabolic risk factors and diseases. METHODS: Seventeen studies on cardiometabolic risk factors and diseases were identified through a systematic search on PubMed, Embase, and Cochrane. Inclusion criteria were studies with
Aronia as intervention, performed in individuals with cardiometabolic disease or risk factors, e. g., type 2 diabetes (T2D), cardiovascular disease, hypertension, dyslipidaemia, impaired glucose tolerance, overweight, central obesity and smoking. Four of these studies were applicable for a
quantitative analysis. RESULTS: Aronia did not influence body weight, circulating triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, or blood pressure. The quantitative analysis revealed a mean reduction in blood glucose of 0.44 mmol/l (P=0.0001) in the treatment
group compared with the control group suggesting that Aronia treatment may have a beneficial impact on blood glucose. In addition, treatment durations of 6 weeks to 3 months tended to decrease low-density lipoprotein (LDL) cholesterol, while shorter treatment durations had no effect on LDL
cholesterol. The quantitative analysis did not provide data on long-term effects of Aronia on lipids. CONCLUSIONS: More long-term high-quality randomized controlled studies are needed to clarify if dietary supplementation with Aronia has beneficial effects on cardiometabolic diseases.
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Affiliation(s)
- Christine B. Christiansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Fredrik B. Mellbye
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Kjeld Hermansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Per B. Jeppesen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Søren Gregersen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
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Khan KS, Overgaard K, Tankisi H, Karlsson P, Devantier L, Gregersen S, Jensen TS, Finnerup NB, Pop-Busui R, Dalgas U, Andersen H. Effects of progressive resistance training in individuals with type 2 diabetic polyneuropathy: a randomised assessor-blinded controlled trial. Diabetologia 2022; 65:620-631. [PMID: 35048156 DOI: 10.1007/s00125-021-05646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to evaluate the effects of progressive resistance training (PRT) on muscle strength, intraepidermal nerve fibre density (IENFD) and motor function in individuals with type 2 diabetic polyneuropathy (DPN) and to compare potential adaptations to those of individuals with type 2 diabetes without DPN and healthy controls. METHODS This was an assessor-blinded trial conducted at the Neurology department, Aarhus University Hospital. Adults with type 2 diabetes, with and without DPN and healthy control participants were randomised to either supervised PRT or non-PRT for 12 weeks. Allocation was concealed by a central office unrelated to the study. The co-primary outcomes were muscle strength in terms of the peak torque of the knee and ankle extensors and flexors, and IENFD. Secondary outcome measures included the 6 min walk test (6MWT), five-time sit-to-stand test (FTSST) and postural stability index obtained by static posturography. RESULTS A total of 109 individuals were enrolled in three groups (type 2 diabetes with DPN [n = 42], type 2 diabetes without DPN [n = 32] and healthy control [n = 35]). PRT resulted in muscle strength gains of the knee extensors and flexors in all three groups using comparative analysis (DPN group, PRT 10.3 ± 9.6 Nm vs non-PRT -0.4 ± 8.2 Nm; non-DPN group, PRT 7.5 ± 5.8 Nm vs non-PRT 0.6 ± 8.8 Nm; healthy control group, PRT 6.3 ± 9.0 Nm vs non-PRT -0.4 ± 8.4 Nm; p<0.05, respectively). Following PRT the DPN group improved the 6MWT (PRT 34.6 ± 40.9 m vs non-PRT 2.7 ± 19.6 m; p=0.001) and the FTSST (PRT -1.5 ± 2.2 s vs non-PRT 1.5 ± 4.6 s; p=0.02). There was no change in IENFD following PRT in any of the groups. CONCLUSIONS/INTERPRETATION PRT improved muscle strength of the knee extensors and flexors and motor function in individuals with type 2 diabetic polyneuropathy at levels comparable with those seen in individuals with diabetes without DPN and healthy control individuals, while no effects were observed in IENFD. TRIAL REGISTRATION ClinicalTrials.gov NCT03252132 FUNDING: Research reported in this paper is part of the International Diabetic Neuropathy Consortium (IDNC) research programme, supported by a Novo Nordisk Foundation Challenge Program grant (grant no. NNF14OC0011633) and Aarhus University.
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Affiliation(s)
- Karolina S Khan
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
- International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Kristian Overgaard
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hatice Tankisi
- International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark
| | - Pall Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Louise Devantier
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holstebro, Denmark
| | | | - Troels S Jensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna B Finnerup
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- International Diabetic Neuropathy Consortium, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Al-Mashhadi ZK, Viggers R, Fuglsang-Nielsen R, Vestergaard P, Gregersen S, Starup-Linde J. The risk of major osteoporotic fractures with GLP-1 receptor agonists when compared to DPP-4 inhibitors: A Danish nationwide cohort study. Front Endocrinol (Lausanne) 2022; 13:882998. [PMID: 36299454 PMCID: PMC9589410 DOI: 10.3389/fendo.2022.882998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) is associated with an increased fracture risk. There is little evidence for the effects of glucagon-like peptide 1 receptor agonists (GLP-1RA) on fracture risk in T2D. We aimed to investigate the risk of major osteoporotic fractures (MOF) for treatment with GLP-1RA compared to dipeptidyl peptidase 4 inhibitors (DPP-4i) as add-on therapies to metformin. METHODS We conducted a population-based cohort study using Danish national health registries. Diagnoses were obtained from discharge diagnosis codes (ICD-10 and ICD-8-system) from the Danish National Patient Registry, and all redeemed drug prescriptions were obtained from the Danish National Prescription Registry (ATC classification system). Subjects treated with metformin in combination with either GLP-1RA or DPP-4i were enrolled from 2007 to 2018. Subjects were propensity-score matched 1:1 based on age, sex, and index date. MOF were defined as hip, vertebral, humerus, or forearm fractures. A Cox proportional hazards model was utilized to estimate hazard rate ratios (HR) for MOF, and survival curves were plotted using the Kaplan-Meier estimator. In addition, Aalen's Additive Hazards model was applied to examine additive rather than relative hazard effects while allowing time-varying effects. RESULTS In total, 42,816 individuals treated with either combination were identified and included. After matching, 32,266 individuals were included in the main analysis (16,133 in each group). Median follow-up times were 642 days and 529 days in the GLP-1RA and DPP-4i group, respectively. We found a crude HR of 0.89 [0.76-1.05] for MOF with GLP-1RA compared to DPP-4i. In the fully adjusted model, we obtained an unaltered HR of 0.86 [0.73-1.03]. For the case of hip fracture, we found a crude HR of 0.68 [0.49-0.96] and a similar adjusted HR. Fracture risk was lower in the GLP-1RA group when examining higher daily doses of the medications, when allowing follow-up to continue after medication change, and when examining hip fractures, specifically. Additional subgroup- and sensitivity analyses yielded results similar to the main analysis. CONCLUSION In our primary analysis, we did not observe a significantly different risk of MOF between treatment with GLP-1RA and DPP-4i. We conclude that GLP-1RA are safe in terms of fracture.
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Affiliation(s)
- Zheer Kejlberg Al-Mashhadi
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Zheer Kejlberg Al-Mashhadi,
| | - Rikke Viggers
- Steno Diabetes Center North Jutland, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Fuglsang-Nielsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Jutland, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Gregersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jakob Starup-Linde
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Starup-Linde J, Ornstrup MJ, Kjær TN, Lykkeboe S, Handberg A, Gregersen S, Harsløf T, Pedersen SB, Vestergaard P, Langdahl BL. Bone Density and Structure in Overweight Men With and Without Diabetes. Front Endocrinol (Lausanne) 2022; 13:837084. [PMID: 35360074 PMCID: PMC8960162 DOI: 10.3389/fendo.2022.837084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/10/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Metabolic syndrome (MetS), type 1 diabetes (T1D), and type 2 diabetes, are associated with an increased risk of fractures; however, the impact of obesity on bone deficits in diabetes is unknown. We aimed to compare markers of bone structure, bone density, and bone turnover in non-diabetic overweight men with MetS and overweight men with T1D or T2D. METHODS AND RESEARCH DESIGN In this cross-sectional study we included participants from two previously described study cohorts consisting of participants with diabetes and participants with MetS. Participants underwent dual-energy X-ray absorptiometry measuring areal bone mineral density (aBMD) at the hip and lumbar spine, High Resolution peripheral Quantitative (HRpQCT) scan of the tibia and radius and measurement of circulating bone turnover markers. We compared groups with unpaired t test and performed multiple linear regression with adjustment for age, body mass index, and smoking. RESULTS We included 33 participants with T1D, 25 participants with T2D, and 34 participants with MetS. Bone turnover markers levels were comparable between T1D and MetS. aBMD at the hip was lower in T1D compared to MetS, also after adjustment. P1NP and Osteocalcin levels were lower among individuals with T2D compared to MetS, whereas aBMD were similar between the groups after multiple adjustments. We observed no difference in volumetric BMD at the tibia or radius between MetS and T1D and T2D, respectively. Participants with T2D had a higher trabecular number and lower trabecular separation compared to individuals with MetS at the tibia, which remained signficant after multiple adjustments. CONCLUSION In conclusion, we observed no clinically important differences in bone density or structure between men with T2D, T1D, or MetS. However, men with T2D displayed lower bone turnover compared to MetS highlighting that T2D per se and not obesity, is associated with low bone turnover.
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Affiliation(s)
- Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
- *Correspondence: Jakob Starup-Linde,
| | - Marie Juul Ornstrup
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Nordstrøm Kjær
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Lykkeboe
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Bønløkke Pedersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Bente Lomholt Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Al-Mashhadi ZK, Viggers R, Starup-Linde J, Vestergaard P, Gregersen S. SGLT2 inhibitor treatment is not associated with an increased risk of osteoporotic fractures when compared to GLP-1 receptor agonists: A nationwide cohort study. Front Endocrinol (Lausanne) 2022; 13:861422. [PMID: 36060970 PMCID: PMC9437938 DOI: 10.3389/fendo.2022.861422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) is associated with an increased fracture risk. It is debated whether sodium-glucose cotransporter 2 (SGLT2) inhibitors influence fracture risk in T2D. We aimed to investigate the risk of major osteoporotic fractures (MOF) with SGLT2 inhibitors compared to glucagon-like peptide 1 (GLP-1) receptor agonists when used as add-on therapies to metformin. METHODS We conducted a population-based cohort study using Danish national health registries. Diagnoses were obtained from discharge diagnosis codes (ICD-10 and ICD-8-system) from the Danish National Patient Registry, and all redeemed drug prescriptions were obtained from the Danish National Prescription Registry (ATC classification system). Subjects treated with metformin in combination with either SGLT2 inhibitors or GLP-1 receptor agonists were identified and enrolled from 2012 to 2018. Subjects were then propensity-score matched 1:1 based on age, sex, and index date. Major osteoporotic fractures (MOF) were defined as hip, vertebral, humerus, or forearm fractures. A Cox proportional hazards model was utilized to estimate hazard rate ratios (HR) for MOF, and survival curves were plotted using the Kaplan-Meier estimator. RESULTS In total, 27,543 individuals treated with either combination were identified and included. After matching, 18,390 individuals were included in the main analysis (9,190 in each group). Median follow-up times were 355 [interquartile range (IQR) 126-780] and 372 [IQR 136-766] days in the SGLT2 inhibitor and GLP-1 receptor agonist group, respectively. We found a crude HR of 0.77 [95% CI 0.56-1.04] for MOF with SGLT2 inhibitors compared to GLP-1 receptor agonists. In the fully adjusted model, we obtained an unaltered HR of 0.77 [95% CI 0.56-1.05]. Results were similar across subgroup- and sensitivity analyses. CONCLUSION These results suggest that SGLT2 inhibitors have no effect on fracture risk when compared to GLP-1 receptor agonists. This is in line with results from previous studies.
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Affiliation(s)
- Zheer Kejlberg Al-Mashhadi
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Zheer Kejlberg Al-Mashhadi,
| | - Rikke Viggers
- Steno Diabetes Center North Jutland, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jakob Starup-Linde
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Jutland, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Gregersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Fuglsang-Nielsen R, Rakvaag E, Vestergaard P, Hermansen K, Gregersen S, Starup-Linde J. The Effects of 12-Weeks Whey Protein Supplements on Markers of Bone Turnover in Adults With Abdominal Obesity - A Post Hoc Analysis. Front Endocrinol (Lausanne) 2022; 13:832897. [PMID: 35422766 PMCID: PMC9001834 DOI: 10.3389/fendo.2022.832897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While osteoporosis is characterized by skeletal fragility due to increased bone turnover and low bone mineral density (BMD), subjects with abdominal obesity and type-2 diabetes have increased risk of bone fractures despite low bone turnover and increased BMD. Diets with increased protein content are reported to increase bone turnover in healthy adults and may be a point of interest in preserving bone strength in subjects with abdominal obesity and/or type-2 diabetes. METHODS We examined the effect of 12-weeks dietary intervention on bone turnover in 64 adults with abdominal obesity using data from the MERITS trial. The trial was a randomized, controlled, double blinded study in which participants were allocated to receive either 60 g/d of whey protein hydrolysate or maltodextrin in combination with either high (30 g/d) or low dietary fiber intake (10 g/d). Primarily, we assessed changes in plasma markers of bone turnover Procollagen type 1 N-terminal propeptide (p1NP), C-terminal telopeptide type-1 collagen (CTX), and parathyroid hormone (PTH) within the four intervention groups. In addition, we measured u-calcium and u-carbamide excretion, 25(OH)D, and BMD by whole body DXA scans. Finally, we compared changes in insulin resistance (Homeostasis-model assessment of insulin resistance, HOMA-IR) with changes in bone turnover markers.The trial was registered at www.clinicaltrials.gov as NCT02931630. RESULTS Sixty-four subjects were included in the study. We did not find any effect of twelve weeks of high protein or high fiber intake on plasma levels of P1NP or CTX. There was a nonsignificant positive association between protein intake and PTH levels (p=0.06). U-calcium and u-carbamide increased in both protein groups. There was a positive association between change in HOMA-IR and PTH (p=0.042), while changes in P1NP and CTX did not associate to changes in HOMA-IR. CONCLUSION Twelve weeks of increased whey protein intake in subjects with abdominal obesity did not affect markers of bone turnover significantly, although tended to increase PTH levels. Dietary fiber intake did not affect bone turnover. We report a positive association between change in HOMA-IR and PTH supporting a hypothesis of insulin resistance as a potential key factor in the expanding field of bone fragility in T2D subjects.
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Affiliation(s)
- Rasmus Fuglsang-Nielsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- *Correspondence: Rasmus Fuglsang-Nielsen,
| | - Elin Rakvaag
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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11
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Al-Mashhadi Z, Viggers R, Fuglsang-Nielsen R, de Vries F, van den Bergh JP, Harsløf T, Langdahl B, Gregersen S, Starup-Linde J. Glucose-Lowering Drugs and Fracture Risk-a Systematic Review. Curr Osteoporos Rep 2020; 18:737-758. [PMID: 33165875 DOI: 10.1007/s11914-020-00638-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is associated with increased fracture risk. The aim of this systematic review was to examine the effects of different classes of glucose-lowering drugs on fracture risk in patients with type 2 DM. The heterogeneity of the included studies did not allow formal statistical analyses. RECENT FINDINGS Sixty studies were included in the review. Metformin, dipeptidylpeptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2-inhibitors do not appear to increase fracture risk. Results for insulin and sulphonylureas were more disparate, although there may be an increased fracture risk related to hypoglycemia and falls with these treatments. Glitazones were consistently associated with increased fracture risk in women, although the evidence was sparser in men. New glucose-lowering drugs are continuously being developed and better understanding of these is leading to changes in prescription patterns. Our findings warrant continued research on the effects of glucose-lowering drugs on fracture risk, elucidating the class-specific effects of these drugs.
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Affiliation(s)
- Z Al-Mashhadi
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - R Viggers
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - R Fuglsang-Nielsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - F de Vries
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - T Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - B Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - S Gregersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - Jakob Starup-Linde
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark.
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12
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Fuglsang-Nielsen R, Rakvaag E, Langdahl B, Knudsen KEB, Hartmann B, Holst JJ, Hermansen K, Gregersen S. Effects of whey protein and dietary fiber intake on insulin sensitivity, body composition, energy expenditure, blood pressure, and appetite in subjects with abdominal obesity. Eur J Clin Nutr 2020; 75:611-619. [PMID: 32948867 DOI: 10.1038/s41430-020-00759-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 08/12/2020] [Accepted: 09/08/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recently, we demonstrated that whey protein (WP) combined with low dietary fiber improved lipemia, a risk factor for cardiovascular disease in subjects with abdominal obesity. In the present study, we investigated the effects of intake of WP and dietary fiber from enzyme-treated wheat bran on other metabolic parameters of the metabolic syndrome. METHODS The study was a 12-week, double-blind, randomized, controlled, parallel intervention study. We randomized 73 subjects with abdominal obesity to 1 of 4 iso-energetic dietary interventions: 60 g per day of either WP hydrolysate or maltodextrin (MD) combined with high-fiber (HiFi; 30 g dietary fiber/day) or low-fiber (LoFi; 10 g dietary fiber/day) cereal products. We assessed changes in insulin sensitivity, gut hormones (GLP-1, GLP-2, GIP, and peptide YY), body composition, 24-h BP, resting energy expenditure and respiratory exchange ratio (RER), and appetite. RESULTS Sixty-five subjects completed the trial. Subjective hunger ratings were lower after 12 weeks of WP compared with MD, independent of fiber content (P = 0.02). We found no effects on ratings of satiety, fullness or prospective food consumption for either of the interventions. Intake of WP combined with LoFi increased the postprandial peptide YY response. There were no effects of WP or fiber on insulin sensitivity, body composition, energy expenditure, incretins, or 24-h BP. CONCLUSIONS WP consumption for 12 weeks reduced subjective ratings of hunger in subjects with abdominal obesity. Neither WP nor dietary fiber from wheat bran affected insulin sensitivity, 24-h BP, gut hormone responses, body composition, or energy expenditure compared with MD and low dietary fiber.
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Affiliation(s)
- Rasmus Fuglsang-Nielsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. .,Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark. .,Steno Diabetes Center Aarhus, Aarhus, Denmark.
| | - Elin Rakvaag
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Clinical Pharmacology, Novo Nordisk A/S, Søborg, Denmark
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bolette Hartmann
- Novo Nordisk Foundation Center for Basic Metabolic Research, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- Novo Nordisk Foundation Center for Basic Metabolic Research, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus, Denmark
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Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) is associated with an increased fracture risk. Weight loss in T2DM management may result in lowering of bone mass. In this systematic literature review, we aimed to investigate how exercise affects bone health in people with T2DM. Furthermore, we examined the types of exercise with the potential to prevent and treat bone fragility in people with T2DM. RECENT FINDINGS Exercise differs in type, mechanical load, and intensity, as does the osteogenic response to exercise. Aerobic exercise improves metabolic health in people with T2DM. However, the weight-bearing component of exercise is essential to bone health. Weight loss interventions in T2DM induce a loss of bone mass that may be attenuated if accompanied by resistance or weight-bearing exercise. Combination of weight-bearing aerobic and resistance exercise seems to be preventive against excessive bone loss in people with T2DM. However, evidence is sparse and clinical trials investigating the effects of exercise on bone health in people with T2DM are warranted.
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Affiliation(s)
- R Viggers
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Z Al-Mashhadi
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - R Fuglsang-Nielsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus C, Denmark
- Department of Internal Medicine, Regional Hospital Randers, Randers, Denmark
| | - S Gregersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - J Starup-Linde
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus C, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
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14
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Fuglsang-Nielsen R, Rakvaag E, Vestergaard P, Hartmann B, Holst JJ, Hermansen K, Gregersen S, Starup-Linde J. Consumption of nutrients and insulin resistance suppress markers of bone turnover in subjects with abdominal obesity. Bone 2020; 133:115230. [PMID: 31954199 DOI: 10.1016/j.bone.2020.115230] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Abdominal obesity and type 2 diabetes are associated with insulin resistance and low bone turnover along with an increased fracture risk. The mode of action is poorly understood. The bone resorption marker, C-terminal telopeptide type 1 collagen (CTX), and to a lesser extent, the bone formation marker, Procollagen type 1 N-terminal propeptide (P1NP) appear to be inhibited by food consumption. The link between food consumption, insulin resistance and bone turnover remains to be clarified. Primarily we aimed to compare the postprandial CTX, P1NP and PTH responses by two frequently applied methods in assessing metabolic health; oral glucose tolerance test (OGTT) and mixed meal tolerance test. Secondly, we explored the effect of insulin resistance on bone marker responses. METHODS We enrolled 64 subjects with abdominal obesity. Following 10 h of fasting, subjects initially underwent a standard OGTT (300 kcal) and approximately one week later a mixed meal tolerance test (1130 kcal). Circulating CTX, P1NP and PTH were assessed on both days at time = 0, after 30 min and after 90 min for comparison of the two interventions. We analyzed glucose and insulin levels for the assessment of insulin resistance. Additionally, we measured plasma calcium levels along with the gut hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like-peptide 2 (GLP-2) in an attempt to identify possible mediators of the postprandial bone response. RESULTS CTX, P1NP and PTH were suppressed by OGTT and the mixed meal; the latter induced a more pronounced suppression after 90 min. Calcium levels were similar between OGTT and meal. GIP and GLP-2 levels increased after both interventions, although only the meal induced a sustained increase after 90 min. Fasting P1NP was inversely associated with insulin resistance. The meal-induced suppression of P1NP (but not CTX or PTH) was inversely associated with level of insulin resistance. CONCLUSION The acute postprandial suppression of bone turnover markers is extended after ingestion of a mixed meal compared to an OGTT. The response appears to be independent of gender and prompted by a reduction in PTH. The study additionally indicates a possible link between the development of insulin resistance and low bone turnover - which may be of key essence in the development of the fragile bone structure and increased fracture risk demonstrated in subjects with abdominal obesity and T2D.
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Affiliation(s)
- Rasmus Fuglsang-Nielsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark.
| | - Elin Rakvaag
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Denmark; Department of Endocrinology, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences and NNF Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences and NNF Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
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15
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Rakvaag E, Fuglsang-Nielsen R, Bach Knudsen KE, Hermansen K, Gregersen S. The Combination of Whey Protein and Dietary Fiber Does Not Alter Low-Grade Inflammation or Adipose Tissue Gene Expression in Adults with Abdominal Obesity. Rev Diabet Stud 2020; 15:83-94. [PMID: 31904760 DOI: 10.1900/rds.2019.15.83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Abdominal obesity is characterized by low-grade inflammation and plays a central role in the development of type 2 diabetes and cardiovascular diseases. Dietary factors can influence low-grade inflammation and affect adipose tissue function. AIM To investigate the separate and combined effects of whey protein and cereal fiber on inflammatory markers and adipose tissue gene expression in abdominal obesity. METHODS We performed a 12-week, double-blind, randomized controlled dietary intervention in 65 adults with abdominal obesity. The participants were randomized to 4 groups using a 2 × 2 factorial design; they received either 60 g/day of whey protein or maltodextrin in combination with high-fiber wheat bran products (30 g fiber/day) or low-fiber refined wheat products (10 g fiber/day). Plasma concentrations of tumor necrosis factor α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), monocyte chemoattractant protein-1 (MCP-1), interleukin 1 receptor antagonist (IL-1Ra), and adiponectin were measured before and after intervention. Changes in gene expression related to inflammation, insulin signaling, and lipid metabolism were measured in abdominal subcutaneous adipose tissue. RESULTS After intervention, TNF-α was reduced for both high-fiber groups compared with baseline, but did not significantly differ from the low-fiber groups. There were no differences in fasting or postprandial inflammatory markers between the groups. The relative gene expression of ribosomal protein S6 kinase B1 (S6K1) was increased after whey protein compared with maltodextrin consumption. CONCLUSION Intake of whey protein in combination with high cereal fiber content did not differentially affect low-grade inflammation or adipose tissue gene expression compared with maltodextrin and low fiber content in individuals with abdominal obesity.
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Affiliation(s)
- Elin Rakvaag
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Rasmus Fuglsang-Nielsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | | | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark; Steno Diabetes Center Aarhus, 8200 Aarhus N, Denmark
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Gu W, Rebsdorf A, Anker C, Gregersen S, Hermansen K, Geuns JMC, Jeppesen PB. Steviol glucuronide, a metabolite of steviol glycosides, potently stimulates insulin secretion from isolated mouse islets: Studies in vitro. Endocrinol Diabetes Metab 2019; 2:e00093. [PMID: 31592450 PMCID: PMC6775443 DOI: 10.1002/edm2.93] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/01/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Steviol glycosides are the sweet components extracted from medicinal plant Stevia rebaudiana Bertoni, which have antihyperglycaemic effects. Steviol glucuronide (SVG) is the metabolite excreted in human urine after oral administration of steviol glycosides. We aimed to clarify whether SVG exerts direct insulin stimulation from pancreatic islets and to explore its mode of action. MATERIALS AND METHODS Insulin secretion was measured after 60 minutes static incubation of isolated mouse islets with (a) 10-9-10-5 mol/L SVG at 16.7 mmol/L glucose and (b) 10-7 mol/L SVG at 3.3-16.7 mmol/L glucose. Islets were perifused with 3.3 or 16.7 mmol/L glucose in the presence or absence of 10-7 mol/L SVG. Gene transcription was measured after 72 hours incubation in the presence or absence of 10-7 mol/L SVG. RESULTS SVG dose-dependently increased insulin secretion from mouse islets with 10-7 mol/L exerting the maximum effect in the presence of 16.7 mmol/L glucose (P < .001). The insulinotropic effect of SVG was critically dependent on the prevailing glucose concentration, and SVG (10-7 mol/L) enhanced insulin secretion at or above 11.1 mmol/L glucose (P < .001) and showed no effect at lower glucose concentrations. During perifusion of islets, SVG (10-7 mol/L) had a long-acting and apparently reversible insulinotropic effect in the presence of 16.7 mmol/L glucose (P < .05). Gene-transcript levels of B2m and Gcgr were markedly altered. CONCLUSION This is the first report to demonstrate that SVG stimulates insulin secretion in a dose- and glucose-dependent manner from isolated mouse islets of Langerhans. SVG may be the main active metabolite after oral intake of steviol glycosides.
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Affiliation(s)
- Wenqian Gu
- Department of Clinical MedicineAarhus UniversityAarhus NDenmark
| | | | - Camilla Anker
- Department of Clinical MedicineAarhus UniversityAarhus NDenmark
| | - Søren Gregersen
- Steno Diabetes Center AarhusAarhus University HospitalAarhus NDenmark
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhus NDenmark
| | - Kjeld Hermansen
- Department of Clinical MedicineAarhus UniversityAarhus NDenmark
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhus NDenmark
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Rakvaag E, Fuglsang-Nielsen R, Bach Knudsen KE, Landberg R, Johannesson Hjelholt A, Søndergaard E, Hermansen K, Gregersen S. Whey Protein Combined with Low Dietary Fiber Improves Lipid Profile in Subjects with Abdominal Obesity: A Randomized, Controlled Trial. Nutrients 2019; 11:nu11092091. [PMID: 31487806 PMCID: PMC6770182 DOI: 10.3390/nu11092091] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 12/22/2022] Open
Abstract
Abdominal obesity is associated with elevated postprandial triglycerides (TG), an independent risk factor for cardiovascular diseases. Previous studies show that whey protein (WP) and dietary fiber may separately reduce postprandial TG. However, few studies have investigated the long-term effects of WP and dietary fiber on postprandial TG. We aimed to investigate the separate and combined long-term effects of WP and dietary fiber from wheat bran on postprandial TG and markers of lipid metabolism in subjects with abdominal obesity. We conducted a 12-week, double-blind, randomized, controlled, parallel intervention study. In a 2 × 2 factorial design, 73 adults were randomized to receive 60 g/day of either WP hydrolysate or maltodextrin (MD) combined with high-fiber wheat bran products (HiFi; 30 g dietary fiber/day) or low-fiber refined wheat products (LoFi; 10 g dietary fiber/day). A high-fat meal test was conducted before and after the intervention. Sixty-five subjects were included in the final analyses. There were no differences between intervention groups in postprandial TG assessed as incremental area under the curve (iAUC). WP-LoFi had reduced postprandial TG assessed as total area under the curve (tAUC) and reduced fasting TG compared with all other groups, and reduced fasting apolipoprotein B-48 compared with MD-LoFi. There were no changes in lipoprotein lipase activity. Total cholesterol and apolipoprotein B-100 were reduced after WP intake compared with MD. Total cholesterol was increased after HiFi intake compared with LoFi. In conclusion, intake of WP in combination with low-fiber cereal products for 12 weeks had beneficial effects on postprandial TG tAUC and fasting TG, but not on postprandial TG iAUC in subjects with abdominal obesity. Combining WP with high-fiber wheat bran products did not improve lipid profile.
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Affiliation(s)
- Elin Rakvaag
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark.
| | - Rasmus Fuglsang-Nielsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | | | - Rikard Landberg
- Department of Biology and Biological Engineering, Chalmers University of Technology, 412 96 Gothenburg, Sweden
| | | | - Esben Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Steno Diabetes Center Aarhus, 8200 Aarhus, Denmark
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Shokouh P, Jeppesen PB, Christiansen CB, Mellbye FB, Hermansen K, Gregersen S. Efficacy of Arabica Versus Robusta Coffee in Improving Weight, Insulin Resistance, and Liver Steatosis in a Rat Model of Type-2 Diabetes. Nutrients 2019; 11:E2074. [PMID: 31484373 PMCID: PMC6770458 DOI: 10.3390/nu11092074] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022] Open
Abstract
The effects of chronic coffee exposure in models of type 2 diabetes mellitus (T2D) models is scarcely studied, and the efficacy of the main coffee species has never been compared. We tested the hypothesis that long-term consumption of arabica and robusta coffee may differentially delay and affect T2D development in Zucker diabetic fatty rats. Three study groups received either chow mixed with arabica or robusta instant coffee (1.8% w/w) or unsupplemented chow food for 10 weeks. Both coffee species reduced liver triglyceride content and area under the curve of fasting and postprandial insulin. At study end, plasma adiponectin, total cholesterol and high density lipoprotein levels were higher in the robust group compared with both arabica and control groups. The liver gene expression of Glucose-6-phosphatase, catalytic subunit (G6pc) and Mechanistic target of rapamycin (mTOR) in robusta and Cpt1a in both coffee groups was downregulated. In conclusion, long-term consumption of both coffee species reduced weight gain and liver steatosis and improved insulin sensitivity in a rat model of T2D. Robusta coffee was seemingly superior to arabica coffee with respect to effects on lipid profile, adiponectin level and hepatic gene expression.
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Affiliation(s)
- Pedram Shokouh
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- The Danish Diabetes Academy, Odense University Hospital, Kløvervænget 10, 5000 Odense C, Denmark
| | - Per B Jeppesen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Christine B Christiansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Fredrik B Mellbye
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
- Steno Diabetes Center, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
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19
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Abstract
Overnight fasting of varying length is common practice when studying glucose and lipid metabolism in rats. However, prolonged fasting may influence insulin sensitivity, and it is unknown to which extent different fasting durations affect postprandial metabolism in rats. The purpose of this study was to investigate the effect of different fasting durations (6-, 12-, or 18-h) on fat tolerance and glucose tolerance in male Sprague Dawley rats. We also aimed to examine the effect of two test fats with different fatty acid composition on postprandial triglycerides. We conducted a fat tolerance test, where butterfat or rapeseed oil was administered in a crossover design (experiment 1), and an oral glucose tolerance test (experiment 2). Regarding the fat tolerance test, we found no effects of fasting duration on triglycerides or free fatty acids, whereas the 18-h fast resulted in reduced glucose and insulin area under the curves. We did not find differential effects of butterfat and rapeseed oil on the outcomes. We found decreased fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR), and increased beta-hydroxybutyric acid concentrations after 18-h fast compared with shorter fasting durations. Regarding the oral glucose tolerance test, both 12-h and 18-h fast resulted in greater peak insulin concentrations than 6-h fast, and peak glucose concentrations were higher after 18-h than 12-h fast. We found no effects of fasting on the insulin sensitivity index. In conclusion, extending the fasting duration had an impact on glucose metabolism in rats, but did not appear to influence fat tolerance.
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Affiliation(s)
- Elin Rakvaag
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Majbritt Dam Lund
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Wiking
- Department of Food Science, Aarhus University, Aarhus, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus, Denmark
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Fuglsang-Nielsen R, Starup-Linde J, Gregersen S, Vestergaard P. The effect of meals on bone turnover - a systematic review with focus on diabetic bone disease. Expert Rev Endocrinol Metab 2018; 13:233-249. [PMID: 30234398 DOI: 10.1080/17446651.2018.1518131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Type 2 diabetes is associated with an increased risk of bone fractures. Bone mineral density (BMD) is increased and bone turnover is low in type 2 diabetes and the increased BMD does not explain the increased fracture risk. However, the low bone turnover may lead to insufficient bone renewal with unrepaired micro-cracks and thus increase fracture risk. Ingestion of food acutely decreases bone resorption markers and the macronutrient composition of meals and meal frequency may influence bone metabolism adversely in subjects with unhealthy eating patterns, e.g., patients with type 2 diabetes. AREAS COVERED The treatment strategy of bone disease in type 2 diabetics is covered in this review. The current management of diabetic bone disease consists of anti-osteoporotic treatment. However, anti-resorptives may further reduce an already low bone turnover with uncertain effects. Furthermore, the acute and long-term effects of meal ingestion, weight loss alone and in combination with exercise as well as the possible underlying mechanisms are covered in this systematic review. EXPERT COMMENTARY Current management of diabetic bone disease is based on principles of anti-osteoporotic treatment in non-diabetic subjects. However, studies are urged to investigate whether anti-resorptives are equally beneficial in type 2 diabetes as in non-diabetic individuals.
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Affiliation(s)
| | - Jakob Starup-Linde
- b Steno Diabetes Center North Jutland , Aalborg University Hospital , Denmark
| | - Søren Gregersen
- a Department of Endocrinology and Internal Medicine , Aarhus University Hospital , Denmark
| | - Peter Vestergaard
- b Steno Diabetes Center North Jutland , Aalborg University Hospital , Denmark
- c Department of Endocrinology , Aalborg University Hospital , Denmark
- d Department of Clinical Medicine , Aalborg University , Denmark
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21
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Gu W, Rebsdorf A, Hermansen K, Gregersen S, Jeppesen PB. The Dynamic Effects of Isosteviol on Insulin Secretion and Its Inability to Counteract the Impaired β-Cell Function during Gluco-, Lipo-, and Aminoacidotoxicity: Studies In Vitro. Nutrients 2018; 10:nu10020127. [PMID: 29373526 PMCID: PMC5852703 DOI: 10.3390/nu10020127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/10/2018] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
Isosteviol (ISV), a diterpene molecule, is an isomer of the backbone structure of a group of substances with proven antidiabetic capabilities. The aim of this study was to investigate if ISV elicits dynamic insulin release from pancreatic islets and concomitantly is able to ameliorate gluco-, lipo-, and aminoacidotoxicity in clonal β-cell line (INS-1E) in relation to cell viability and insulin secretion. Isolated mice islets placed into perifusion chambers were perifused with 3.3 mM and 16.7 mM glucose with/without 10−7 M ISV. INS-1E cells were incubated for 72 h with either 30 mM glucose, 1 mM palmitate or 10 mM leucine with or without 10−7 M ISV. Cell viability was evaluated with a Cytotoxic Fluoro-test and insulin secretion was measured in Krebs-Ringer Buffer at 3.3 mM and 16.7 mM glucose. In the presence of 3.3 mM glucose, 10−7 M ISV did not change basal insulin secretion from perifused islets. However, at a high glucose level of 16.7 mM, 10−7 M ISV elicited a 2.5-fold increase (−ISV: 109.92 ± 18.64 ng/mL vs. +ISV: 280.15 ± 34.97 ng/mL; p < 0.01). After 72 h gluco-, lipo-, or aminoacidotoxicity in INS-1E cells, ISV treatment did not significantly affect cell viability (glucotoxicity, −ISV: 19.23 ± 0.83%, +ISV: 18.41 ± 0.90%; lipotoxicity, −ISV: 70.46 ± 3.15%, +ISV: 65.38 ± 2.81%; aminoacidotoxicity: −ISV: 8.12 ± 0.63%; +ISV: 7.75 ± 0.38%, all nonsignificant). ISV did not improve impaired insulin secretion (glucotoxicity, −ISV: 52.22 ± 2.90 ng/mL, +ISV: 47.24 ± 3.61 ng/mL; lipotoxicity, −ISV: 19.94 ± 4.10 ng/mL, +ISV: 22.12 ± 3.94 ng/mL; aminoacidotoxicity: −ISV: 32.13 ± 1.00 ng/mL; +ISV: 30.61 ± 1.54 ng/mL, all nonsignificant). In conclusion, ISV acutely stimulates insulin secretion at high but not at low glucose concentrations. However, ISV did not counteract cell viability or cell dysfunction during gluco-, lipo-, or aminoacidotoxicity in INS-1E cells.
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Affiliation(s)
- Wenqian Gu
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - Andreas Rebsdorf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - Per Bendix Jeppesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
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O'Neill S, Larsen MB, Gregersen S, Hermansen K, O'Driscoll L. miR-758-3p: a blood-based biomarker that's influence on the expression of CERP/ABCA1 may contribute to the progression of obesity to metabolic syndrome. Oncotarget 2018; 9:9379-9390. [PMID: 29507696 PMCID: PMC5823618 DOI: 10.18632/oncotarget.24314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/02/2018] [Indexed: 01/22/2023] Open
Abstract
Due to increasing prevalence of obesity, a simple method or methods for the diagnosis of metabolic syndrome are urgently required to reduce the risk of associated cardiovascular disease, diabetes and cancer. This study aimed to identify a miRNA biomarker that may distinguish metabolic syndrome from obesity and to investigate if such a miRNA may have functional relevance for metabolic syndrome. 52 adults with clinical obesity (n=26) or metabolic syndrome (n=26) were recruited. Plasma specimens were procured from all and were randomly designated to discovery and validation cohorts. miRNA discovery profiling was performed, using array technology, on plasma RNA. Validation was performed by quantitative polymerase chain reaction. The functional effect of miR-758-3p on its predicted target, cholesterol efflux regulatory protein/ATP-binding cassette transporter, was investigated using HepG2 liver cells. Custom miRNA profiling of 25 miRNAs in the discovery cohort found miR-758-3p to be detected in the obese cohort but undetected in the metabolic syndrome cohort. miR-758-3p was subsequently validated as a potential biomarker for metabolic syndrome by quantitative polymerase chain reaction. Bioinformatics analysis identified cholesterol efflux regulatory protein/ATP-binding cassette transporter as miR-758-3p’s predicted target. Specifically, mimicking miR-758-3p in HepG2 cells suppressed cholesterol efflux regulatory protein/ATP-binding cassette transporter protein expression; conversely, inhibiting miR-758-3p increased cholesterol efflux regulatory protein/ATP-binding cassette transporter protein expression. miR-758-3p holds potential as a blood-based biomarker for distinguishing progression from obesity to metabolic syndrome and as a driver in controlling cholesterol efflux regulatory protein/ATP-binding cassette transporter expression, indicating it potential role in cholesterol control in metabolic syndrome.
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Affiliation(s)
- Sadhbh O'Neill
- School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Mette Bohl Larsen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Søren Gregersen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Kjeld Hermansen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Lorraine O'Driscoll
- School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
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23
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Starup-Linde J, Westberg-Rasmussen S, Lykkeboe S, Handberg A, Hartmann B, Holst JJ, Hermansen K, Vestergaard P, Gregersen S. Glucose Tolerance Tests and Osteocalcin Responses in Healthy People. Front Endocrinol (Lausanne) 2018; 9:356. [PMID: 30057568 PMCID: PMC6053521 DOI: 10.3389/fendo.2018.00356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/13/2018] [Indexed: 12/29/2022] Open
Abstract
Aim: Osteocalcin and undercarboxylated osteocalcin are suggested to be endocrine messengers from the bones and have been shown to stimulate insulin secretion from pancreatic β-cells. Insulin is hypothesized to increase the osteoblastic production of osteocalcin. The aim of the study was to investigate whether the route of glucose administration influence the circulating levels of osteocalcin and undercarboxylated osteocalcin. Methods: Twelve healthy males were enrolled in an acute cross-over study where they underwent an oral glucose tolerance test (OGTT), an isoglycemic intravenous glucose infusion (IIGI) and a fasting period (control). Blood samples were collected throughout 180 min and analyzed for osteocalcin and undercarboxylated osteocalcin and compared to insulin, glucose, and gastro-intestinal hormone responses. Results: Neither osteocalcin levels nor undercarboxylated osteocalcin levels over time differed between the OGTT, IIGI, and fasting. Baseline insulin levels and glucose levels were not associated with osteocalcin or undercarboxylated osteocalcin levels. Increases in insulin and glucose levels were neither associated with altered osteocalcin nor undercarboxylated osteocalcin levels. Conclusion: The route of glucose administration does not influence the circulating levels of osteocalcin and undercarboxylated osteocalcin despite the differential insulin and incretin responses. In the acute setting this suggests that insulin does not increase osteoblastic production of osteocalcin in healthy human males.
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Affiliation(s)
- Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- *Correspondence: Jakob Starup-Linde
| | | | - Simon Lykkeboe
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences and The NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jens J. Holst
- Department of Biomedical Sciences and The NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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24
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Amer B, Clausen MR, Bertram HC, Bohl M, Nebel C, Zheng H, Skov T, Larsen MK, Gregersen S, Hermansen K, Dalsgaard TK. Consumption of Whey in Combination with Dairy Medium‐Chain Fatty Acids (MCFAs) may Reduce Lipid Storage due to Urinary Loss of Tricarboxylic Acid Cycle Intermediates and Increased Rates of MCFAs Oxidation. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201601048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/10/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Bashar Amer
- Department of Food ScienceAarhus University Tjele/Årslev Denmark
| | | | | | - Mette Bohl
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
| | - Caroline Nebel
- Department of Food ScienceAarhus University Tjele/Årslev Denmark
| | - Hong Zheng
- Department of Food ScienceAarhus University Tjele/Årslev Denmark
| | - Thomas Skov
- Department of Food ScienceFaculty of ScienceUniversity of Copenhagen Fredriksberg C Denmark
| | - Mette Krogh Larsen
- Department of Food ScienceAarhus University Tjele/Årslev Denmark
- Arla Foods Videbaek Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus Denmark
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25
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Yan X, Wang Z, Westberg-Rasmussen S, Tarbier M, Rathjen T, Tattikota SG, Peck BCE, Kanke M, Oxvig C, Frystyk J, Starup-Linde J, Sethupathy P, Friedländer MR, Gregersen S, Poy MN. Differential Impact of Glucose Administered Intravenously and Orally on Circulating miR-375 Levels in Human Subjects. J Clin Endocrinol Metab 2017; 102:3749-3755. [PMID: 28973164 DOI: 10.1210/jc.2017-01365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/25/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND To date, numerous nucleic acid species have been detected in the systemic circulation including microRNAs (miRNAs); however, their functional role in this compartment remains unclear. OBJECTIVE The aim of this study was to determine whether systemic levels of miRNAs abundant in blood, including the neuroendocrine tissue-enriched miR-375, are altered in response to a glucose challenge. DESIGN Twelve healthy males were recruited for an acute crossover study that consisted of two tests each following an 8-hour fasting period. An oral glucose tolerance test (OGTT) was performed, and blood samples were collected over a 3-hour period. Following a period of at least 1 week, the same participants were administered an isoglycemic intravenous glucose infusion (IIGI) with the same blood-collection protocol. RESULTS The glucose response curve following the IIGI mimicked that obtained after the OGTT, but as expected, systemic insulin levels were lower during the IIGI compared with the OGTT (P < 0.05). miR-375 levels in circulation were increased only in response to an OGTT and not during an IIGI. In addition, the response to the OGTT also coincided with the transient increase of circulating glucagon-like peptide (GLP)-1, GLP-2, and glucose-dependent insulinotropic polypeptide. CONCLUSIONS The present findings show levels of miR-375 increase following administration of an OGTT and, in light of its enrichment in cells of the gut, suggest that the gastrointestinal tract may play an important role in the abundance and function of this miRNA in the blood.
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Affiliation(s)
- Xin Yan
- Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
| | - Zhen Wang
- Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
| | - Sidse Westberg-Rasmussen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Marcel Tarbier
- Science for Life Laboratory, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 17121 Stockholm, Sweden
| | - Thomas Rathjen
- Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
| | | | - Bailey C E Peck
- Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Matt Kanke
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853
| | - Claus Oxvig
- Department of Molecular Biology and Genetics, Science and Technology, Aarhus University, DK-8000 Aarhus, Denmark
| | - Jan Frystyk
- Medical Research Laboratory, Department of Clinical Medicine, Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Praveen Sethupathy
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853
| | - Marc R Friedländer
- Science for Life Laboratory, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 17121 Stockholm, Sweden
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Matthew N Poy
- Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
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Mellbye FB, Jeppesen PB, Shokouh P, Laustsen C, Hermansen K, Gregersen S. Cafestol, a Bioactive Substance in Coffee, Has Antidiabetic Properties in KKAy Mice. J Nat Prod 2017; 80:2353-2359. [PMID: 28763212 DOI: 10.1021/acs.jnatprod.7b00395] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Daily coffee consumption is inversely associated with risk of type-2 diabetes (T2D). Cafestol, a bioactive substance in coffee, increases glucose-stimulated insulin secretion in vitro and increases glucose uptake in human skeletal muscle cells. We hypothesized that cafestol can postpone development of T2D in KKAy mice. Forty-seven male KKAy mice were randomized to consume chow supplemented daily with either 1.1 (high), 0.4 (low), or 0 (control) mg of cafestol for 10 weeks. We collected blood samples for fasting glucose, glucagon, and insulin as well as liver, muscle, and fat tissues for gene expression analysis. We isolated islets of Langerhans and measured insulin secretory capacity. After 10 weeks of intervention, fasting plasma glucose was 28-30% lower in cafestol groups compared with the control group (p < 0.01). Fasting glucagon was 20% lower and insulin sensitivity improved by 42% in the high-cafestol group (p < 0.05). Cafestol increased insulin secretion from isolated islets by 75-87% compared to the control group (p < 0.001). Our results show that cafestol possesses antidiabetic properties in KKAy mice. Consequently, cafestol may contribute to the reduced risk of developing T2D in coffee consumers and has a potential role as an antidiabetic drug.
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Affiliation(s)
- Fredrik Brustad Mellbye
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Per Bendix Jeppesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Pedram Shokouh
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
- The Danish Diabetes Academy, Odense University Hospital , Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
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Støy J, Olsen J, Park SY, Gregersen S, Hjørringgaard CU, Bell GI. In vivo measurement and biological characterisation of the diabetes-associated mutant insulin p.R46Q (GlnB22-insulin). Diabetologia 2017; 60:1423-1431. [PMID: 28478482 PMCID: PMC8785399 DOI: 10.1007/s00125-017-4295-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/31/2017] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Heterozygous mutations in the insulin gene that affect proinsulin biosynthesis and folding are associated with a spectrum of diabetes phenotypes, from permanent neonatal diabetes to MODY. In vivo studies of these mutations may lead to a better understanding of insulin mutation-associated diabetes and point to the best treatment strategy. We studied an 18-year-old woman with MODY heterozygous for the insulin mutation p.R46Q (GlnB22-insulin), measuring the secretion of mutant and wild-type insulin by LC-MS. The clinical study was combined with in vitro studies of the synthesis and secretion of p.R46Q-insulin in rat INS-1 insulinoma cells. METHODS We performed a standard 75 g OGTT in the 18-year-old woman and measured plasma glucose and serum insulin (wild-type insulin and GlnB22-insulin), C-peptide, proinsulin, glucagon and amylin. The affinity of GlnB22-insulin was tested on human insulin receptors expressed in baby hamster kidney (BHK) cells. We also examined the subcellular localisation, secretion and impact on cellular stress markers of p.R46Q-insulin in INS-1 cells. RESULTS Plasma GlnB22-insulin concentrations were 1.5 times higher than wild-type insulin at all time points during the OGTT. The insulin-receptor affinity of GlnB22-insulin was 57% of that of wild-type insulin. Expression of p.R46Q-insulin in INS-1 cells was associated with decreased insulin secretion, but not induction of endoplasmic reticulum stress. CONCLUSIONS/INTERPRETATION The results show that beta cells can process and secrete GlnB22-insulin both in vivo and in vitro. Our combined approach of immunoprecipitation and LC-MS to measure mutant and wild-type insulin may be useful for the study of other mutant insulin proteins. The ability to process and secrete a mutant protein may predict a more benign course of insulin mutation-related diabetes. Diabetes develops when the beta cell is stressed because of increased demand for insulin, as observed in individuals with other insulin mutations that affect the processing of proinsulin to insulin or mutations that reduce the affinity for the insulin receptor.
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Affiliation(s)
- Julie Støy
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
| | | | - Soo-Young Park
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Søren Gregersen
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Graeme I Bell
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
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Krawczel P, Ferneborg S, Wiking L, Dalsgaard T, Gregersen S, Black R, Larsen T, Agenäs S, Svennersten-Sjaunja K, Ternman E. Milking time and risk of over-milking can be decreased with early teat cup removal based on udder quarter milk flow without loss in milk yield. J Dairy Sci 2017; 100:6640-6647. [DOI: 10.3168/jds.2016-12312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/20/2017] [Indexed: 11/19/2022]
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Westberg-Rasmussen S, Starup-Linde J, Hermansen K, Holst JJ, Hartmann B, Vestergaard P, Gregersen S. Differential impact of glucose administered intravenously or orally on bone turnover markers in healthy male subjects. Bone 2017; 97:261-266. [PMID: 28126633 DOI: 10.1016/j.bone.2017.01.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/12/2017] [Accepted: 01/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with type-1 (T1D) and type-2 diabetes mellitus (T2D) have an increased risk of hip fracture. The underlying mechanisms may involve disturbances in the incretin hormones. Our aim was to clarify if glucose administration i.e. orally or intravenously differentially affects bone turnover markers in healthy males. METHODS 12 healthy males were included in a cross-over study consisting of three tests following an 8hour fast. First, an oral glucose tolerance test (OGTT) was performed. Subsequently, we carried out an isoglycemic intravenous glucose infusion (IIGI) that closely mimicked the glucose response curve to the oral glucose load. We analyzed blood samples for the bone turnover markers serum C-terminal telopeptide of type I collagen (s-CTX) and serum procollagen type I N propeptide (s-P1NP), as well as insulin, glucose, gastric inhibitory peptide (GIP), glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-2 (GLP-2). Finally, eight of the twelve participants underwent a control experiment where they fasted for 3h (Control). RESULTS While OGTT induced a 50% reduction in s-CTX, only a ~30% reduction was seen during the IIGI and the Control. Neither intervention influenced s-P1NP. The concentration of insulin was highest during the OGTT. However, insulin was also increased significantly during the IIGI compared to the Control. Plasma concentrations of GIP, GLP-1 and GLP-2 were higher under the OGTT than during the IIGI and Control. A linear regression indicated that peak p-GIP significantly predicts nadir s-CTX (p=0.03), and that peak p-GIP could explain 34% of the variability in nadir s-CTX (adjusted R2=0.34). CONCLUSION This study indicates that glucose per se does not acutely affect bone turnover markers. However, gastrointestinal hormones, especially GIP, possibly in combination with hyperglycemia, may have an acute, uncoupling effect on bone turnover leading to a decrease in bone resorption but no change in bone formation.
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Affiliation(s)
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences and The NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences and The NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Clinical Institute, Aalborg University and University Hospital, Aalborg, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Starup-Linde J, Gregersen S, Frost M, Vestergaard P. Use of glucose-lowering drugs and risk of fracture in patients with type 2 diabetes. Bone 2017; 95:136-142. [PMID: 27890548 DOI: 10.1016/j.bone.2016.11.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetes mellitus is associated with an increased risk of hip fracture. The aim of this cohort study was to investigate whether glucose-lowering drugs influence the risk of hip fracture in patients with incident diabetes. METHODS A study was performed on a cohort of patients with incident type 2 diabetes. Diabetes diagnosis was defined using information from the Danish National Patient Registry and reimbursement information of glucose-lowering drugs from the Register of Medicinal Product Statistics. The period of observation was from 01.01.1996 till 31.12.2011. The primary exposure was glucose-lowering drugs and the primary endpoint was hip fracture. Unadjusted, adjusted, and propensity score adjusted Cox regressions were performed. RESULTS 5244 patients with type 2 diabetes with a mean follow up of 5.5years were included in the study. Use of sulphonylureas within the last 90days was associated with hip fracture in patients with type 2 diabetes, hazard ratio 1.64 (95% confidence interval: 1.54,1.75), whereas ever use of sulohonylyreas was not associated with an increased risk of fractures. Use of sulphonylureas within the last 90days was also associated with an increased risk of fractures at other sites. Use of glitazones within the last 90days was associated with an increased risk of hip fracture, hazard ratio 2.07 (95% confidence interval: 1.39,3.07), whereas ever use was not associated with an increased risk. CONCLUSIONS Current use of sulphonylureas was associated with hip fracture in patients with type 2 diabetes. Speculatively, this may be due to hypoglycemia resulting in falls.
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Affiliation(s)
- Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Clinical Institute, Aalborg University, Aalborg, Denmark.
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Frost
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Peter Vestergaard
- Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Hald S, Schioldan AG, Moore ME, Dige A, Lærke HN, Agnholt J, Bach Knudsen KE, Hermansen K, Marco ML, Gregersen S, Dahlerup JF. Effects of Arabinoxylan and Resistant Starch on Intestinal Microbiota and Short-Chain Fatty Acids in Subjects with Metabolic Syndrome: A Randomised Crossover Study. PLoS One 2016; 11:e0159223. [PMID: 27434092 PMCID: PMC4951149 DOI: 10.1371/journal.pone.0159223] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 05/25/2016] [Indexed: 12/20/2022] Open
Abstract
Recently, the intestinal microbiota has been emphasised as an important contributor to the development of metabolic syndrome. Dietary fibre may exert beneficial effects through modulation of the intestinal microbiota and metabolic end products. We investigated the effects of a diet enriched with two different dietary fibres, arabinoxylan and resistant starch type 2, on the gut microbiome and faecal short-chain fatty acids. Nineteen adults with metabolic syndrome completed this randomised crossover study with two 4-week interventions of a diet enriched with arabinoxylan and resistant starch and a low-fibre Western-style diet. Faecal samples were collected before and at the end of the interventions for fermentative end-product analysis and 16S ribosomal RNA bacterial gene amplification for identification of bacterial taxa. Faecal carbohydrate residues were used to verify compliance. The diet enriched with arabinoxylan and resistant starch resulted in significant reductions in the total species diversity of the faecal-associated intestinal microbiota but also increased the heterogeneity of bacterial communities both between and within subjects. The proportion of Bifidobacterium was increased by arabinoxylan and resistant starch consumption (P<0.001), whereas the proportions of certain bacterial genera associated with dysbiotic intestinal communities were reduced. Furthermore, the total short-chain fatty acids (P<0.01), acetate (P<0.01) and butyrate concentrations (P<0.01) were higher by the end of the diet enriched with arabinoxylan and resistant starch compared with those resulting from the Western-style diet. The concentrations of isobutyrate (P = 0.05) and isovalerate (P = 0.03) decreased in response to the arabinoxylan and resistant starch enriched diet, indicating reduced protein fermentation. In conclusion, arabinoxylan and resistant starch intake changes the microbiome and short-chain fatty acid compositions, with potential beneficial effects on colonic health and metabolic syndrome. TRIAL REGISTRATION ClinicalTrials.gov NCT01618526.
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Affiliation(s)
- Stine Hald
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Grethe Schioldan
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mary E. Moore
- Department of Food Science and Technology, University of California Davis, Davis, California, United States of America
| | - Anders Dige
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Agnholt
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maria L. Marco
- Department of Food Science and Technology, University of California Davis, Davis, California, United States of America
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens F. Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Starup-Linde J, Gejl M, Borghammer P, Knop FK, Gregersen S, Rungby J, Vestergaard P. Vagotomy and subsequent development of diabetes - A nested case-control study. Metabolism 2016; 65:954-60. [PMID: 27282866 DOI: 10.1016/j.metabol.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/05/2016] [Accepted: 04/07/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vagal signaling is involved in gastric emptying and the secretion and effect of a number of hormones regulating gluco-metabolic processes and, thus, crucial for metabolic homeostasis. PURPOSE We hypothesized that vagotomy would increase the risk of developing type 2 diabetes and examined the association between vagotomy and subsequent development of diabetes. METHODS A nested case-control study was conducted with information on cases and controls from the Danish National Patient Registry. Cases included individuals with a diabetes diagnosis subsequent (>12months) to the first registration of vagotomy and/or upper gastrointestinal disease in the period 1977-2011. Controls had no subsequent diagnosis of diabetes and were matched by incidence density sampling, age and gender. Logistic regression analyses were conducted. RESULTS 501,724 diabetes patients and 1,375,567 matched controls were included in the analysis. Vagotomy was performed on 2772 individuals and 148,489 individuals had an upper gastrointestinal diagnosis. In this combined population, 30,902 were diagnosed with diabetes. The mean follow-up was 16years. The unadjusted odds ratio for developing diabetes following vagotomy was 0.64 (95% confidence interval (CI): 0.58-0.71) and did not change in an adjusted analysis (0.64, 95% CI: 0.58-0.70). When restricting the multivariate-adjusted analysis to patients with type 2 diabetes and type 1 diabetes, respectively, the multivariate odds ratios were 0.79 (95% CI: 0.70-0.89) and 0.75 (95% CI 0.53-1.08), respectively. CONCLUSION Vagotomy was associated with a significantly decreased risk of developing type 2 diabetes in a population of patients with upper gastrointestinal disease.
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Affiliation(s)
- Jakob Starup-Linde
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Michael Gejl
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of Biomedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Rungby
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Liu Z, Jeppesen PB, Gregersen S, Bach Larsen L, Hermansen K. Chronic Exposure to Proline Causes Aminoacidotoxicity and Impaired Beta-Cell Function: Studies In Vitro. Rev Diabet Stud 2016; 13:66-78. [PMID: 27563695 DOI: 10.1900/rds.2016.13.66] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pancreatic islet-cell dysfunction is a hallmark in the development of diabetes, but the reasons for the primary β-cell defect are still elusive. Elevated circulating proline levels have been found in subjects with insulin resistance, obesity, and type 2 diabetes. Therefore, we assessed β-cell function, gene expressions, and cell death after long-term exposure of pancreatic β-cells to excess proline in vitro. METHODS Isolated mouse islets and INS-1E cells were incubated with and without excess proline. After 72 h, we examined: (1) β-cell function, including basal insulin secretion (BIS) and glucose-stimulated insulin secretion (GSIS), (2) transcription factors related to insulin gene expression and enzymes involved in the tricarboxylic acid cycle and cholesterol biogenesis, (3) cellular triglycerides (TG) and cholesterol content, (4) the death of INS-1E cells and 3H thymidine incorporation, and (5) protein expression of INS-1E cells in response to proline by proteomics. RESULTS We found that high doses of proline increased BIS and decreased GSIS in both isolated mouse islets and INS-1E cells. MafA, insulin 1, and the cytochrome c oxidase subunit VIa polypeptide 2 mRNA expressions were all downregulated, indicating that proline impaired insulin gene transcription and mitochondrial oxidative phosphorylation. In contrast, mevalonate decarboxylase gene expression was upregulated, and simultaneously, cholesterol content in INS-1E cells was enhanced. Protein profiling of INS-1E cells revealed that cytosolic non-specific dipeptidase and α enolase were differentially expressed. CONCLUSIONS Our results indicate that proline-induced insulin transcription and mitochondrial oxidative phosphorylation impairment may contribute to the β-cell dysfunction observed in type 2 diabetes. Caution should be applied in interpreting the pathophysiological role of proline since very high proline concentrations were used in the experiments.
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Affiliation(s)
- Zhenping Liu
- Department of Medicine and Endocrinology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark
| | - Per B Jeppesen
- Department of Medicine and Endocrinology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark
| | - Søren Gregersen
- Department of Medicine and Endocrinology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark
| | - Lotte Bach Larsen
- Department of Food Science, Faculty of Agricultural Sciences, Aarhus University, DK-8230 Tjele, Denmark
| | - Kjeld Hermansen
- Department of Medicine and Endocrinology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark
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Bohl M, Bjørnshave A, Gregersen S, Hermansen K. Whey and Casein Proteins and Medium-Chain Saturated Fatty Acids from Milk Do Not Increase Low-Grade Inflammation in Abdominally Obese Adults. Rev Diabet Stud 2016; 13:148-157. [PMID: 28012280 PMCID: PMC5553764 DOI: 10.1900/rds.2016.13.148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/04/2015] [Accepted: 12/10/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low-grade inflammation is involved in the development of diabetes and cardiovascular disease (CVD). Inflammation can be modulated by dietary factors. Dairy products are rich in saturated fatty acids (SFA), which are known to possess pro-inflammatory properties. However, different fatty acid compositions may exert different effects. Other components such as milk proteins may exert anti-inflammatory properties which may compensate for the potential negative effects of SFAs. Generally, the available data suggest a neutral role of dairy product consumption on inflammation. AIM To investigate the effects of, and potential interaction between, a dietary supplementation with whey protein and milk fat, naturally enriched in medium-chain SFA (MC-SFA), on inflammatory markers in abdominal obese adults. METHODS The study was a 12-week, randomized, double-blinded, intervention study. Sixty-three adults were equally allocated to one of four groups which received a supplement of either 60 g/day whey or 60 g/day casein plus 63 g/day milk fat either high or low in MC-SFA content. Fifty-two subjects completed the study. Before and after the intervention, changes in plasma interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1RA), high-sensitive C-reactive protein (hsCRP), adiponectin, and monocyte chemoattractant protein-1 (MCP-1) were measured. Changes in inflammatory genes in the subcutaneous adipose tissue were also documented. RESULTS There were no differences in circulating inflammatory markers between protein types or fatty acid compositions in abdominally obese subjects, with the exception of an increase in adiponectin in response to high compared to low MC-SFA consumption in women. We found that combined dairy proteins and MC-SFAs influenced inflammatory gene expression in adipose tissue, while no effect was detected by dairy proteins or MC-SFA per se. CONCLUSION Whey protein compared with casein and MC-SFA-enriched milk fat did not alter circulating markers of low-grade inflammation in abdominally obese subjects, except for an increase in circulating adiponectin in response to high MC-SFA in abdominally obese women.
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Affiliation(s)
- Mette Bohl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ann Bjørnshave
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Starup-Linde J, Lykkeboe S, Gregersen S, Hauge EM, Langdahl BL, Handberg A, Vestergaard P. Bone Structure and Predictors of Fracture in Type 1 and Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:928-36. [PMID: 26756117 DOI: 10.1210/jc.2015-3882] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT Type 1 and type 2 diabetes mellitus are associated with an increased risk of fracture. OBJECTIVE The objective of the study was to compare the bone structure and density between type 1 and type 2 diabetes patients and to investigate fracture associations. DESIGN This was a cross-sectional study. SETTING AND PATIENTS Physician-diagnosed type 1 and type 2 diabetes patients were included from the outpatient clinics at two university hospitals participated in the study. MAIN OUTCOME MEASURES Bone density and structure were assessed by dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Blood samples were collected for bone turnover markers. Prevalent vertebral fractures were assessed by vertebral fracture assessment and x-ray, and incident fractures were collected from The Danish National Hospital Discharge Register. RESULTS Bone mineral density (BMD) was higher in type 2 than type 1 diabetes patients at the hip, femur, and spine; however, only the hip differed in multivariate-adjusted models. Bone tissue stiffness at the tibia was increased in type 2 diabetes patients also in adjusted models. Sclerostin levels were inversely associated with fracture in type 1 diabetes patients. The patients with the highest tertile of sclerostin had an 81% decreased risk of a fracture compared with the lowest tertile. CONCLUSIONS Type 1 and type 2 diabetes patients differ in BMD of the hip and tissue stiffness at the tibia. Sclerostin may be a marker independent of BMD to predict fractures in type 1 diabetes patients and thus potentially of clinical importance. Studies with longer follow-up are needed.
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Affiliation(s)
- Jakob Starup-Linde
- Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Simon Lykkeboe
- Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Søren Gregersen
- Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Ellen-Magrethe Hauge
- Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Bente Lomholt Langdahl
- Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Aase Handberg
- Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Peter Vestergaard
- Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark
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Abstract
OBJECTIVES Diabetes mellitus is associated with an increased risk of fractures, which is not fully explained by bone mineral density and common risk factors. The aim of this study is to investigate the association of medication and biochemical markers on the risk of fracture in a diabetes population. DESIGN AND SETTING A nested case-control study was conducted based on Danish diabetes patients from The Danish National Hospital Discharge Registry. PARTICIPANTS The cases of the study were diabetes patients with a fracture (n=24,349), and controls were diabetes patients with no fracture (n=132,349). A total of 2627 diabetes patients were available for an analysis of patient characteristics, comorbidities, biochemical parameters and drug usage. RESULTS Age (OR=1.02, 95% CI 1.01 to 1.04), diabetes duration (OR=1.06, 95% CI 1.02 to 1.09), a diagnosis of previous fracture (OR=2.20, 95% CI 1.55 to 3.11), an alcohol-related diagnosis (OR=2.94, 95% CI 1.76 to 4.91), total cholesterol level (OR=2.50, 95% CI 1.20 to 5.21) and the usage of antiepileptics (OR=2.12, 95% CI 1.39 to 3.59) all increased the odds of fracture. Low-density lipoprotein cholesterol levels decreased the odds of fracture (OR =0.34, 95% CI 0.16 to 0.74), where the level of 3.04-5.96 mmol/L was optimal with regard to fracture risk. CONCLUSIONS Low-density lipoprotein cholesterol may improve our understanding of fractures in diabetes patients, and it may be added to current fracture risk models in diabetes patients.
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Affiliation(s)
- Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital THG, Aarhus, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital THG, Aarhus, Denmark
| | - Peter Vestergaard
- Clinical Institute, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Starup-Linde J, Lykkeboe S, Gregersen S, Hauge EM, Langdahl BL, Handberg A, Vestergaard P. Differences in biochemical bone markers by diabetes type and the impact of glucose. Bone 2016; 83:149-155. [PMID: 26555635 DOI: 10.1016/j.bone.2015.11.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/17/2015] [Accepted: 11/05/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diabetes mellitus is associated with an increased fracture risk, however the fracture risk is 7 fold increased in patients with type 1 diabetes (T1D) and 1.4 fold increased in patients with type 2 diabetes (T2D) with decreased and increased bone mineral density, respectively. Oral ingestion of glucose causes an acute decrease in bone turnover markers, and thus glucose levels may affect bone turnover in diabetes. OBJECTIVE The aim was to examine disparities in bone turnover markers between patients with T1D and T2D and evaluate the effect of glucose on bone turnover. METHODS A cross-sectional study was conducted. Patients diagnosed with T1D (n=98) or T2D (n=96) were included from the outpatient clinics at two University Hospitals. All individuals had normal renal function. Glucose and bone turnover markers were measured in non-fasting blood samples. RESULTS P-procollagen type 1 amino terminal propeptide (P1NP), p-osteocalcin (OC), and s-Receptor Activator of Nuclear factor Kappa beta Ligand (RANKL) were lower in patients with T2D compared to T1D, and s-osteoprotegerin (OPG) was higher in T2D. P-C-terminal cross-linked telopeptide of type-I collagen (CTX), p-fibroblast growth factor-23 (FGF-23), p-sclerostin, and p-undercarboxylated osteocalcin (ucOC) were similar in between the two groups of patients. Increasing non-fasting glucose levels were inversely related to p-CTX, p-P1NP, p-OC, and p-ucOC and directly related to s-OPG in simple linear and multiple linear regressions adjusted for factors influencing bone turnover markers including HbA1c. CONCLUSION Bone turnover markers were lower in patients with T2D compared to T1D. Acute blood glucose alterations may change bone turnover mediated by OPG and have detrimental effects on bone health in diabetes. TRIAL REGISTRATION NUMBER ClinicalTrials.govNCT01870557.
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Affiliation(s)
- Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Simon Lykkeboe
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bente Lomholt Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Aase Handberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Mellbye FB, Jeppesen PB, Hermansen K, Gregersen S. Cafestol, a Bioactive Substance in Coffee, Stimulates Insulin Secretion and Increases Glucose Uptake in Muscle Cells: Studies in Vitro. J Nat Prod 2015; 78:2447-2451. [PMID: 26465380 DOI: 10.1021/acs.jnatprod.5b00481] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diet and exercise intervention can delay or prevent development of type-2-diabetes (T2D), and high habitual coffee consumption is associated with reduced risk of developing T2D. This study aimed to test whether selected bioactive substances in coffee acutely and/or chronically increase insulin secretion from β-cells and improve insulin sensitivity in skeletal muscle cells. Insulin secretion from INS-1E rat insulinoma cells was measured after acute (1-h) and long-term (72-h) incubation with bioactive substances from coffee. Additionally, we measured uptake of radioactive glucose in human skeletal muscle cells (SkMC) after incubation with cafestol. Cafestol at 10(-8) and 10(-6) M acutely increased insulin secretion by 12% (p < 0.05) and 16% (p < 0.001), respectively. Long-term exposure to 10(-10) and 10(-8) M cafestol increased insulin secretion by 34% (p < 0.001) and 68% (p < 0.001), respectively. Caffeic acid also increased insulin secretion acutely and chronically. Chlorogenic acid, trigonelline, oxokahweol, and secoisolariciresinol did not significantly alter insulin secretion acutely. Glucose uptake in SkMC was significantly enhanced by 8% (p < 0.001) in the presence of 10(-8) M cafestol. This newly demonstrated dual action of cafestol suggests that cafestol may contribute to the preventive effects on T2D in coffee drinkers and be of therapeutic interest.
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Affiliation(s)
- Fredrik Brustad Mellbye
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C Denmark
| | - Per Bendix Jeppesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Tage-Hansens Gade 2, 8000 Aarhus C Denmark
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Bislev LS, Bruun BJ, Gregersen S, Knudsen ST. Prevalence of cancer in Danish patients referred to a fast-track diagnostic pathway is substantial. Dan Med J 2015; 62:A5138. [PMID: 26324087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Danish patients diagnosed with cancer who present with unspecific signs and symptoms are diagnosed with unfavourable delay, which has led to the establishment of a national fast-track (cancer) pathway. The aim of this study was to estimate the prevalence of cancer and other diagnoses in patients referred to this programme at Aarhus University Hospital from general practitioners. Furthermore, we aimed to characterise the patient cohort, assess survival and estimate the predictive values of symptoms, signs and biochemical abnormalities. METHODS From 1 March 2011 to 31 December 2013, data of interest were consecutively collected from the electronic patient record by two medical doctors. RESULTS Overall, 18% (58/323) had cancer, but the prevalence decreased from 22% in 2011 to 16% in 2013. Haematological cancers and cancers originating from the digestive system were the predominant cancer diagnoses. Patients diagnosed with cancer unfortunately had a high mortality suggesting that we diagnose cancer in the late, non-curable stages. Patients referred to the fast-track pathway had a median of four symptoms, most commonly weight loss and fatigue. In one fourth of the patients, a final diagnosis was not reached at discharge. For the rest (n = 185), gastrointestinal conditions, infectious and rheumatological diseases were most common. The predictive value of the presenting symptoms was poor. Age and biochemical markers considered as unspecific markers of cancer were better predictors. Anaemia was seen in 71% versus 34% of patients with/without diagnosed cancer, respectively. CONCLUSIONS Unspecific signs and symptoms that may be indicative of cancer represent a clinical challenge. A fast-track (cancer) pathway is a new option for patients not entitled to enter an organ-specific programme.
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Affiliation(s)
- Lise Sofie Bislev
- Medicinsk-Endokrinologisk Afdeling, MEA, Akutcentret, Aarhus Universitetshospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
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Neergaard-Petersen S, Hvas AM, Grove EL, Larsen SB, Gregersen S, Kristensen SD. The Influence of Haemoglobin A1c Levels on Platelet Aggregation and Platelet Turnover in Patients with Coronary Artery Disease Treated with Aspirin. PLoS One 2015; 10:e0132629. [PMID: 26148094 PMCID: PMC4493028 DOI: 10.1371/journal.pone.0132629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/16/2015] [Indexed: 12/23/2022] Open
Abstract
Background Hyperglycaemia may attenuate the antiplatelet effect of aspirin and thereby increase the risk of cardiovascular events. We investigated the influence of increased haemoglobin A1c (HbA1c) levels on platelet aggregation and turnover in a large cohort of patients with coronary artery disease (CAD) with type 2 diabetes, prediabetes or no diabetes. Methods In this observational study, we included 865 stable CAD patients on 75 mg aspirin as mono-therapy of whom 242 patients had type 2 diabetes and were receiving antidiabetic drugs. Among 623 patients without diabetes, we classified 303 patients with prediabetes (HbA1c ≥5.7–6.4% [39–47 mmol/mol]) naive to antidiabetic drugs. Platelet aggregation was evaluated by the Multiplate Analyzer using arachidonic acid and collagen and by the VerifyNow Aspirin. Platelet turnover was evaluated by immature platelets using flow cytometry and platelet activation by soluble P-selectin. Results CAD patients with type 2 diabetes had higher platelet aggregation (all p-values <0.01), platelet turnover (immature platelet count, p<0.01) and platelet activation (p<0.001) than patients without diabetes. CAD patients with prediabetes had increased platelet aggregation (p = 0.02) and platelet count (p = 0.02) compared with patients without diabetes. Increased levels of HbA1c correlated positively with increased platelet aggregation using arachidonic acid (r = 0.19, p<0.0001), collagen (r = 0.10, p<0.01) and VerifyNow (r = 0.15, p<0.0001), and with platelet count (r = 0.08, p = 0.01), immature platelet count (r = 0.11, p<0.001) and soluble P-selectin (r = 0.15, p<0.0001). These associations were mainly evident in non-diabetic and prediabetic CAD patients. Conclusions CAD patients with prediabetes and diabetes may have attenuated antiplatelet effect of aspirin compared with CAD patients without diabetes. This may be related to increased platelet count in patients with prediabetes. Increased levels of HbA1c correlated positively, though weakly, with increased platelet aggregation, platelet turnover and platelet activation.
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Affiliation(s)
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Søren Gregersen
- Department of Endocrinology and Internal Medicine MEA, Aarhus University Hospital, Aarhus, Denmark
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Bislev LS, Mortensen J, Gustafsson LN, Gregersen S, Munk-Jørgensen P. Poor quality of referral from mental to somatic hospitals. Dan Med J 2015; 62:A5085. [PMID: 26036884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Concomitant somatic and mental illness is associated with excess mortality compared with the general population. To prevent this, a number of health initiatives relating to somatic illness in psychiatric patients have recently been introduced. One of the means used to screen for and treat somatic disease in psychiatric patients is highly qualified referral for somatic specialist assessment. The aim of this study was to assess the quality of referral of psychiatric patients to specialists in internal medicine. METHODS A total of 110 consecutive referrals were collected from August to November in 2012 and 2013. Regional guidelines define the requirement for the satisfactory referral scheme and using these guidelines as a reference, each referral was rated based on indexation and an overall assessment. A report about the 2012 results was presented to the hospital management. The management of the hospital was not informed about the 2013 replication of the study. RESULTS Half of the topics assessed were inadequately completed. Information about somatic co-morbidity was missing in 76% of the referrals. Description of relevant tests and physical examinations was missing in 53%. By overall assessment, 40% of the referrals were rated as being insufficient. The resident physicians stand out by producing the most informative referrals. The 2013 results improved compared with 2012. CONCLUSION We call for improvement in the quality of the referrals among psychiatric in-patients to somatic specialists. We propose an expansion of the use of standardised schemes and a strengthening of the skills needed to write a good referral.
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Affiliation(s)
- Lise Sofie Bislev
- Medicinsk-Endokrinologisk Afdeling, Aarhus Universitetshospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
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Bohl M, Bjørnshave A, Rasmussen KV, Schioldan AG, Amer B, Larsen MK, Dalsgaard TK, Holst JJ, Herrmann A, O'Neill S, O'Driscoll L, Afman L, Jensen E, Christensen MM, Gregersen S, Hermansen K. Dairy proteins, dairy lipids, and postprandial lipemia in persons with abdominal obesity (DairyHealth): a 12-wk, randomized, parallel-controlled, double-blinded, diet intervention study. Am J Clin Nutr 2015; 101:870-8. [PMID: 25833983 DOI: 10.3945/ajcn.114.097923] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/17/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Abdominal obesity and exaggerated postprandial lipemia are independent risk factors for cardiovascular disease (CVD) and mortality, and both are affected by dietary behavior. OBJECTIVE We investigated whether dietary supplementation with whey protein and medium-chain saturated fatty acids (MC-SFAs) improved postprandial lipid metabolism in humans with abdominal obesity. DESIGN We conducted a 12-wk, randomized, double-blinded, diet intervention study. Sixty-three adults were randomly allocated to one of 4 diets in a 2 × 2 factorial design. Participants consumed 60 g milk protein (whey or casein) and 63 g milk fat (with high or low MC-SFA content) daily. Before and after the intervention, a high-fat meal test was performed. We measured changes from baseline in fasting and postprandial triacylglycerol, apolipoprotein B-48 (apoB-48; reflecting chylomicrons of intestinal origin), free fatty acids (FFAs), insulin, glucose, glucagon, glucagon-like peptide 1 (GLP-1), and gastric inhibitory polypeptide (GIP). Furthermore, changes in the expression of adipose tissue genes involved in lipid metabolism were investigated. Two-factor ANOVA was used to examine the difference between protein types and fatty acid compositions, as well as any interaction between the two. RESULTS Fifty-two participants completed the study. We found that the postprandial apoB-48 response decreased significantly after whey compared with casein (P = 0.025) independently of fatty acid composition. Furthermore, supplementation with casein resulted in a significant increase in the postprandial GLP-1 response compared with whey (P = 0.003). We found no difference in postprandial triacylglycerol, FFA, insulin, glucose, glucagon, or GIP related to protein type or MC-SFA content. We observed no interaction between milk protein and milk fat on postprandial lipemia. CONCLUSION We found that a whey protein supplement decreased the postprandial chylomicron response compared with casein in persons with abdominal obesity, thereby indicating a beneficial impact on CVD risk. This trial was registered at clinicaltrials.gov as NCT01472666.
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Affiliation(s)
- Mette Bohl
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Ann Bjørnshave
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Kia V Rasmussen
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Anne Grethe Schioldan
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Bashar Amer
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Mette K Larsen
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Trine K Dalsgaard
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Jens J Holst
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Annkatrin Herrmann
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Sadhbh O'Neill
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Lorraine O'Driscoll
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Lydia Afman
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Erik Jensen
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Merete M Christensen
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Søren Gregersen
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
| | - Kjeld Hermansen
- From the Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (MB, AB, KVR, AGS, SG, and KH); the Department of Food Science, Aarhus University, Tjele, Denmark (BA, MKL, and TKD); NNF Centre for Basic Metabolic Research and the Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark (JJH); Unilabs A/S, Copenhagen, Denmark (AH); the School of Pharmacy & Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland (SO and LO); the Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands (LA); Arla Foods Ingredients Group P/S, Viby J., Denmark (EJ); and GCO Corporate Research and Innovation, Viby J., Denmark (MMC)
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Abstract
AIM The main objective was to investigate the physiological effects of ancient wheat whole grain flour diets on the development and progression of type 2 diabetes in Zucker diabetic fatty (ZDF) rats, and specifically to look at the acute glycemic responses. METHODS An intervention study was conducted, involving 40 ZDF rats consuming one of 5 different diets (emmer, einkorn, spelt, rye and refined wheat) for 9 weeks. Refined wheat flour and whole grain rye flour were included as negative and positive controls, respectively. RESULTS After 9 weeks of intervention, a downregulation of the hepatic genes PPAR-α, GLUT2, and SREBP-1c was observed in the emmer group compared to the control wheat group. Likewise, expression of hepatic SREBP-2 was lower for emmer, einkorn, and rye compared with the control group. Furthermore, spelt and rye induced a low acute glycemic response. The wheat group had higher HDL- and total cholesterol levels. CONCLUSIONS Ancient wheat diets caused a downregulation of key regulatory genes involved in glucose and fat metabolism, equivalent to a prevention or delay of diabetes development. Spelt and rye induced a low acute glycemic response compared to wheat.
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Affiliation(s)
- Anne Cathrine Thorup
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, Aarhus C, Denmark
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, Aarhus C, Denmark
| | - Per Bendix Jeppesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, Aarhus C, Denmark
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Westberg-Rasmussen S, Starup-Linde J, Gregersen S, Vestergaard P. Predictors of mortality subsequent to a fracture in diabetes mellitus patients. Front Endocrinol (Lausanne) 2015; 6:46. [PMID: 25883588 PMCID: PMC4381711 DOI: 10.3389/fendo.2015.00046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/16/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Type-1 and type-2 diabetes mellitus (DM) are associated with an increased fracture risk and possibly an increased risk of death following a fracture. AIM To investigate the association between diabetes-related drugs and mortality following a fracture. METHODS A nested case-control study was conducted. Cases were patients with DM who died following a fracture; controls were DM patients not dying after a fracture. We identified DM patients using the Danish National Hospital Discharge Register (1977-2011) and included information on date of DM diagnosis, date of fracture, and comorbidities. From the Danish Cause of Death Register, the date of death was collected (2008-2011). From the Central Region of Jutland, Denmark, medication use was collected (2008-2011). Analysis was performed by unconditional logistic regression. RESULTS Two thousand six hundred twenty one diabetes patients with a fracture following the diabetes diagnosis and with information on medication use were included. Of these, 229 died. In a multivariate analysis, statin use [n = 1,106 (42%) statin users, odds ratio (OR) = 0.60, 95% confidence interval, p = 0.012] decreased the risk of dying subsequent to a fracture. Male gender (OR = 1.57, p = 0.005), increasing age (OR = 1.08, p < 0.001), a diagnosis of retinopathy (OR = 2.12, p = 0.008), heart failure (OR = 1.68, p = 0.004), and use of glucocorticoids (OR = 2.22, p = 0.001) were associated with an increased risk of death. None of the antidiabetics: biguanides, glucagon-like receptor agonists, β-cell stimulants, glitazones, and insulin were associated with mortality. CONCLUSION Co-morbidity reflected by late onset complications, heart failure, and glucocorticoid use was associated with an increased risk of mortality subsequent to a fracture. Statin use may reduce mortality subsequent to a fracture in diabetes patients. Clinical trials are needed to determine whether diabetes patients with a fracture should initiate statin treatment.
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Affiliation(s)
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University, Aalborg, Denmark
- *Correspondence: Jakob Starup-Linde, Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage Hansens Gade 2, Aarhus C 8000, Denmark e-mail:
| | - Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University, Aalborg, Denmark
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Gregersen S, Bystrup S, Overgaard A, Jeppesen PB, Sønderstgaard Thorup AC, Jensen E, Hermansen K. Effects of whey proteins on glucose metabolism in normal Wistar rats and Zucker diabetic fatty (ZDF) rats. Rev Diabet Stud 2014; 10:252-69. [PMID: 24841879 DOI: 10.1900/rds.2013.10.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Beneficial effects of milk protein on glucose metabolism have been reported. OBJECTIVES We hypothesized that dietary supplementation with specific milk protein fractions could prevent diabetes and differentially alter tissue gene expression. Therefore, we studied the effects of supplementing the diet with whey isolate, whey hydrolysate, Α-lactalbumin, and casein proteins in Zucker Diabetic Fatty rats (ZDF) and normal Wistar rats. A chow diet was included as well. METHODS Six week old male ZDF (n = 60) and Wistar rats (n = 44) were used in a 13 week study. P-glucose, p-insulin, p-glucagon, HbA1c, total-cholesterol, HDL-cholesterol, and triglycerides were measured. An oral glucose tolerance test (OGTT) was performed. Liver, muscle, and adipose samples were used for RT-PCR. One-way ANOVA and multiple comparison tests were performed. RESULTS HbA1c increased during intervention, and was significantly lower for all milk protein fractions compared to chow in the ZDF rats (p < 0.05). At week 18, iAUCs during OGTT in the ZDF rats were similar for all milk protein-treated groups and significantly lower than in the chow fed group (p < 0.01). In the chow-fed group of ZDF rats, p-glucagon increased significantly compared to all milk protein fed animals. Total and HDL cholesterol were increased in the milk protein-treated ZDF rats compared with the control group. Expression of liver GYS2 and SREBP-2 were downregulated in the milk protein-fed ZDF groups compared with chow. CONCLUSIONS We conclude that milk protein fractions improve glycemic indices in diabetic rats. No major differences were seen between the milk protein fractions. However, the fractions had a differential impact on tissue gene expression, most pronounced in ZDF rats.
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Affiliation(s)
- Søren Gregersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Sara Bystrup
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Ann Overgaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Per B Jeppesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Anne C Sønderstgaard Thorup
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Erik Jensen
- Arla Foods Ingredients Group P/S, Sonderhoj 10-12, 8260 Viby J, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
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46
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Gregersen S. Bipolar disease and excess mortality - is 'hidden' glucose part of the game? Acta Psychiatr Scand 2014; 129:75. [PMID: 24033229 DOI: 10.1111/acps.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Gregersen
- Department of Endocrinology and Metabolism MEA, Aarhus University Hospital, Aarhus, Denmark.
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47
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Gregersen S. [Good glycaemic control can prevent diabetic peripheral neuropathy]. Ugeskr Laeger 2013; 175:2022-2025. [PMID: 23992909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Diabetic peripheral neuropathy (DPN) results in excess morbidity and mortality. Good glycaemic control is the only way to reduce the risk of DPN. A Cochrane review meta-analysed RCTs on the impact of improved glycaemic control on peripheral neuropathy (primary outcome). The few studies addressing the primary outcome showed that improving glycaemic control reduces clinical neuropathy in type 1 diabetes whereas the evidence is less for type 2 diabetes. Several secondary outcomes (e.g. motor nerve conduction) are also improved. Prevention of DPN is a delicate balance between good glycaemic control and reducing the risk of severe hypoglycaemia.
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Affiliation(s)
- Søren Gregersen
- Medicinsk Endokrinologisk Afdeling MEA, Aarhus Universitetshospital, Tage-Hansens Gade 2, Aarhus C.
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Pietraszek A, Hermansen K, Pedersen SB, Langdahl BL, Holst JJ, Gregersen S. Effects of a meal rich in medium-chain saturated fat on postprandial lipemia in relatives of type 2 diabetics. Nutrition 2013; 29:1000-6. [DOI: 10.1016/j.nut.2013.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 10/26/2022]
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Christensen AS, Viggers L, Hasselström K, Gregersen S. Effect of fruit restriction on glycemic control in patients with type 2 diabetes--a randomized trial. Nutr J 2013; 12:29. [PMID: 23497350 PMCID: PMC3599615 DOI: 10.1186/1475-2891-12-29] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 02/27/2013] [Indexed: 12/03/2022] Open
Abstract
Background Medical nutrition therapy is recognized as an important treatment option in type 2 diabetes. Most guidelines recommend eating a diet with a high intake of fiber-rich food including fruit. This is based on the many positive effects of fruit on human health. However some health professionals have concerns that fruit intake has a negative impact on glycemic control and therefore recommend restricting the fruit intake. We found no studies addressing this important clinical question. The objective was to investigate whether an advice to reduce the intake of fruit to patients with type 2 diabetes affects HbA1c, bodyweight, waist circumference and fruit intake. Methods This was an open randomized controlled trial with two parallel groups. The primary outcome was a change in HbA1c during 12 weeks of intervention. Participants were randomized to one of two interventions; medical nutrition therapy + advice to consume at least two pieces of fruit a day (high-fruit) or medical nutrition therapy + advice to consume no more than two pieces of fruit a day (low-fruit). All participants had two consultations with a registered dietitian. Fruit intake was self-reported using 3-day fruit records and dietary recalls. All assessments were made by the “intention to treat” principle. Results The study population consisted of 63 men and women with newly diagnosed type 2 diabetes. All patients completed the trial. The high-fruit group increased fruit intake with 125 grams (CI 95%; 78 to 172) and the low-fruit group reduced intake with 51 grams (CI 95%; -18 to −83). HbA1c decreased in both groups with no difference between the groups (diff.: 0.19%, CI 95%; -0.23 to 0.62). Both groups reduced body weight and waist circumference, however there was no difference between the groups. Conclusions A recommendation to reduce fruit intake as part of standard medical nutrition therapy in overweight patients with newly diagnosed type 2 diabetes resulted in eating less fruit. It had however no effect on HbA1c, weight loss or waist circumference. We recommend that the intake of fruit should not be restricted in patients with type 2 diabetes. Trial registration http://www.clinicaltrials.gov; Identifier: NCT01010594.
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Correia M, Neves-Petersen MT, Jeppesen PB, Gregersen S, Petersen SB. UV-light exposure of insulin: pharmaceutical implications upon covalent insulin dityrosine dimerization and disulphide bond photolysis. PLoS One 2012; 7:e50733. [PMID: 23227203 PMCID: PMC3515625 DOI: 10.1371/journal.pone.0050733] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/24/2012] [Indexed: 12/11/2022] Open
Abstract
In this work we report the effects of continuous UV-light (276 nm, ~2.20 W.m(-2)) excitation of human insulin on its absorption and fluorescence properties, structure and functionality. Continuous UV-excitation of the peptide hormone in solution leads to the progressive formation of tyrosine photo-product dityrosine, formed upon tyrosine radical cross-linkage. Absorbance, fluorescence emission and excitation data confirm dityrosine formation, leading to covalent insulin dimerization. Furthermore, UV-excitation of insulin induces disulphide bridge breakage. Near- and far-UV-CD spectroscopy shows that UV-excitation of insulin induces secondary and tertiary structure losses. In native insulin, the A and B chains are held together by two disulphide bridges. Disruption of either of these bonds is likely to affect insulin's structure. The UV-light induced structural changes impair its antibody binding capability and in vitro hormonal function. After 1.5 and 3.5 h of 276 nm excitation there is a 33.7% and 62.1% decrease in concentration of insulin recognized by guinea pig anti-insulin antibodies, respectively. Glucose uptake by human skeletal muscle cells decreases 61.7% when the cells are incubated with pre UV-illuminated insulin during 1.5 h. The observations presented in this work highlight the importance of protecting insulin and other drugs from UV-light exposure, which is of outmost relevance to the pharmaceutical industry. Several drug formulations containing insulin in hexameric, dimeric and monomeric forms can be exposed to natural and artificial UV-light during their production, packaging, storage or administration phases. We can estimate that direct long-term exposure of insulin to sunlight and common light sources for indoors lighting and UV-sterilization in industries can be sufficient to induce irreversible changes to human insulin structure. Routine fluorescence and absorption measurements in laboratory experiments may also induce changes in protein structure. Structural damage includes insulin dimerization via dityrosine cross-linking or disulphide bond disruption, which affects the hormone's structure and bioactivity.
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Affiliation(s)
- Manuel Correia
- Department of Physics and Nanotechnology, Aalborg University, Aalborg, Denmark
| | - Maria Teresa Neves-Petersen
- International Iberian Nanotechnology Laboratory (INL), Braga, Portugal
- NanoBiotechnology Group, Department of Biotechnology, Chemistry and Environmental Sciences, Aalborg University, Aalborg, Denmark
- * E-mail:
| | - Per Bendix Jeppesen
- Aarhus University Hospital, Aarhus Sygehus THG, Department of Medicine and Endocrinology MEA, Aarhus C, Denmark
| | - Søren Gregersen
- Aarhus University Hospital, Aarhus Sygehus THG, Department of Medicine and Endocrinology MEA, Aarhus C, Denmark
| | - Steffen B. Petersen
- International Iberian Nanotechnology Laboratory (INL), Braga, Portugal
- NanoBiotechnology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- The Institute for Lasers, Photonics and Biophotonics, University at Buffalo, The State University of New York, Buffalo, New York, United States of America
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