Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man

Efficacy and safety of dapagliflozin compared to pioglitazone in diabetic and non-diabetic patients with non-alcoholic steatohepatitis: A randomized clinical trial

BACKGROUND

Non-alcoholic steatohepatitis (NASH) is a serious end-stage spectrum of non-alcoholic fatty liver disease (NAFLD) with associated high risk of hepatic and extrahepatic complications. Several studies showed the significant beneficial effect of dapagliflozin on body composition, hepatic and metabolic parameters on NAFLD/NASH patients. The study aimed to investigate the efficacy and safety of dapagliflozin in both diabetic and non-diabetic biopsy-proven NASH patients; compared to pioglitazone.

METHODS

This was a four-group, prospective, randomized, parallel, open label study in which 100 biopsy-proven NASH patients were selected, stratified to diabetics and non-diabetics and randomized with 1:1 allocation to either 30 mg pioglitazone or 10 mg dapagliflozin, once daily for 24 weeks. Histological evaluation, anthropometric measures, hepatic, metabolic biochemical markers, fibrosis non-invasive markers, quality of life (QOL) and medications adverse events were examined.

RESULTS

Dapagliflozin showed a comparable histological effect to pioglitazone in both diabetic and non-diabetic patients (P>0.05). As assessed by transient elastography, it also showed a comparable effect on liver fibrosis grade improvement from baseline in diabetics (P=0.287) versus a significant superiority in non-diabetics (P=0.018). Dapagliflozin showed a significant superiority in all anthropometric measures (P<0.001) and QOL (P<0.05) among both diabetics and non-diabetics. There was a significant interaction between interventions and diabetes status on change from baseline of hepatic and metabolic panel collectively (P=0.023) in favor to dapagliflozin among diabetics.

CONCLUSION

Compared to pioglitazone, dapagliflozin had a comparable effect histologically, superior effect biochemically among diabetics and superior effect on liver fibrosis, steatosis and insulin resistance among non-diabetics.

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov, identifier number NCT05254626.

Assessment of TyG Index and Modified TyG Indices in Type 2 Diabetes Mellitus: Evaluating Their Potential as Predictors of Glycemic Control

Introduction The triglyceride glucose (TyG) index and modified TyG-indices have been suggested as a reliable indication of insulin resistance. The present study aimed to investigate the predictive utility of TyG index and modified TyG indices (TyG-waist circumference, TyG-body mass index, TyG-waist-to-hip ratio, and TyG-waist-to-height ratio) for assessing glycemic control in type 2 diabetes mellitus (T2DM). Methods The present hospital-based cross-sectional study recruited 383 T2DM patients. On the basis of HbA1c levels, patients were grouped into poor glycemic control (n=168) and good glycemic control (n=215). Baseline and biochemical parameters including TyG and modified TyG indices were compared between the groups. We used a Spearman correlation analysis to look for an association between TyG and TyG-related indices and glycemic control. We conducted receiver operating characteristic curve analysis to evaluate the predictive capability of TyG-index and modified TyG indices in assessing poor glycemic control in T2DM. Results T2DM with poor glycemic control had significantly elevated TyG and modified TyG indices when compared to those with good glycemic control. The TyG index and modified TyG indices showed a strong correlation with glycemic control in individuals with T2DM. The TyG index exhibited greater predictive capacity for poor glycemic control as compared to the modified TyG indices. Conclusion Patients with T2DM who are treated in clinical settings with limited resources may benefit from using the TyG index to evaluate their glycemic control.

Effect of Preoperative Carbohydrate Loading on Postoperative Recovery of Individuals Who Have Type 2 Diabetes After Total Knee Arthroplasty: A Randomized Controlled Trial

BACKGROUND

Many individuals undergoing surgery involving general anesthesia are asked to fast for a prolonged period to ensure perioperative safety, yet this can initiate stress reactions and insulin resistance, harming postoperative recovery. Such fasting may be particularly problematic for those who have type 2 diabetes. Here, we assessed how giving such individuals' oral carbohydrates before total knee arthroplasty can affect outcomes.

METHODS

We randomized 90 patients who had non-insulin-dependent type 2 diabetes mellitus who were scheduled for elective total knee arthroplasty at one medical center between April 2022 and January 2023 to receive oral carbohydrates at two or four hours before surgery or to receive a carbohydrate-free "placebo" drink at four hours before surgery. The three groups were compared in terms of postoperative blood glucose, insulin resistance, β cell activity, postoperative wound complications, and other clinical outcomes.

RESULTS

The group who received oral carbohydrates at two or four hours before surgery showed significantly lower insulin resistance than the placebo group (group at two hours, 9.0 ± 3.4; group at four hours, 15.8 ± 6.9 versus placebo, 30.9 ± 10.5, P < 0.001) and lower β cell activity (207.7 ± 106.7%; group at four hours, 243.2 ± 114.9% versus 421.5 ± 209.3%, P < 0.001). Those groups were also significantly less likely than the placebo group to experience preoperative hunger or postoperative hyperglycemia. Among patients who received oral carbohydrates, those who received them two hours before surgery showed significantly lower insulin resistance and better glycemic control on postoperative day 1 than those who received carbohydrates four hours before surgery. None of the subjects developed intraoperative aspiration or experienced severe postoperative complications.

CONCLUSION

Oral carbohydrates at two to four hours before total knee arthroplasty are safe and can significantly alleviate preoperative hunger while mitigating postoperative insulin resistance and improving glycemic control in patients who have non-insulin-dependent type 2 diabetes mellitus.

Macrovascular Function in People with HIV After Recent SARS-CoV-2 Infection

Background

People with HIV (PWH) are at increased risk of vascular dysfunction and cardiovascular disease (CVD). SARS-CoV-2 infection has been associated with acute CVD complications. The aim of the study was to as-sess macrovascular function as an early indicator of CVD risk in PWH after mild SARS-CoV-2 infection.

Methods

PWH aged 20-60 years, with undetectable viral load (RNA < 20 copies/mL), on stable antiretroviral therapy (≥6 months) and history of mild COVID-19 (≥30 days) without any CVD manifestations prior to enrollment were recruited. Participants were excluded if they had history of diabetes mellitus, end-stage renal disease, heart or respiratory disease. Participants were matched 1:1 to pre-pandemic PWH. A health survey, surrogate measures of CVD risk, and macrovascular function (brachial artery flow-mediated vasodilation and arterial stiffness assessments via applanation tonometry) were compared between group.

Results

A total of 17 PWH and history of COVID-19 (PWH/COV+) were matched with 17 PWH without COVID-19 (PWH/COV-) pre-pandemic. Mean age (45.5 years), sex (76.5% male), body mass index (27.3), and duration of HIV infection (12.2 years) were not different between groups. Both groups had comparable CVD risk factors (total cholesterol, LDL, HDL, systolic and diastolic blood pressure). There were no differences in measures of flow mediated arterial dilatation or arterial stiffness after 30 days of SARS-CoV-2 infection.

Conclusions

After recent SARS-CoV-2 infection, PWH did not demonstrate evidence of macrovascular dysfunction and increased CVD risk. Results suggest that CVD risk may not be increased in people with well-controlled HIV who did not manifest CVD complications SARS-CoV-2 infection.

Endothelial dysfunction in middle-aged and older men with low testosterone is associated with elevated circulating endothelin-1

Low testosterone in middle-aged/older men contributes to accelerated vascular aging, including endothelial dysfunction. However, the mechanisms by which low testosterone affects endothelial dysfunction are not well understood. We sought to determine whether higher endothelin-1 (ET-1) levels are associated with reduced brachial artery flow-mediated dilation (FMD) in middle-aged/older men with low testosterone. Plasma ET-1 was quantified in 60 men categorized as young (n = 20, age = 30 ± 4 yr, testosterone = 510 ± 63 ng/dL), middle-aged/older with normal testosterone (n = 20, age = 59 ± 6 yr, testosterone = 512 ± 115 ng/dL), or middle-aged/older with low testosterone (n = 20, age = 60 ± 8 yr, testosterone = 265 ± 47 ng/dL). Endothelial function was determined via brachial artery FMD. Venous and arterial endothelial cells were harvested via endovascular biopsy in a subset of participants and stained for ET-1 expression. Middle-aged/older men with normal testosterone exhibited lower brachial artery FMD (5.7 ± 2.2%) compared with young men (7.3 ± 1.3%, P = 0.020), which was exaggerated in middle-aged/older men with low testosterone (4.0 ± 1.8%, P = 0.010 vs. middle-aged/older men with normal testosterone). Plasma ET-1 was not different between young (5.6 ± 0.9 ng/dL) and middle-aged/older men with normal testosterone (6.0 ± 1.4 ng/dL, P = 0.681) but was higher in middle-aged/older men with low testosterone (7.7 ± 2.8 ng/dL) compared with both groups (P < 0.001 vs. young men; P = 0.013 vs. middle-aged/older men with normal testosterone). There was no difference in venous (P = 0.616) or arterial (P = 0.222) endothelial cell ET-1 expression between groups. There was a significant inverse association between plasma ET-1 and FMD (r =-0.371, P = 0.004). These data suggest that the accelerated age-associated reduction in endothelial dysfunction in middle-aged/older men with low testosterone is related to higher circulating ET-1.NEW & NOTEWORTHY Middle-aged/older men with low testosterone have reduced vascular endothelial function compared with young and age-matched men with normal testosterone. In this manuscript, we demonstrate that men with low testosterone have higher plasma endothelin-1, which is associated with worse brachial artery flow-mediated dilation. The source of higher plasma endothelin-1 remains unknown; however, higher circulating endothelin-1 appears to be a mechanism contributing to reduced vascular endothelial function in men with low testosterone.

Wrist Circumference as a Predictor of Abnormal Cardiometabolic Risk in Children and Adolescents with Obesity

Objective: The objective of this study was to evaluate the utility of wrist circumference (WrC) as a predictor of abnormal cardiometabolic risk (CMR) in children and adolescents with obesity. Methods: A cross-sectional study was conducted from July 2024 to September 2024. Children with obesity (aged 5-17.9 years) were categorized into metabolic syndrome (MetS) and non-MetS groups according to the International Diabetes Federation consensus criteria for pediatric MetS. Participants were divided into three groups based on their pubertal stages: pre-pubertal, pubertal, and post-pubertal. Results: A total of 307 children and adolescents with obesity were analyzed, comprising 160 females and 147 males, with a median age of 12.9 years (interquartile range 4.2). MetS was diagnosed in 94 participants (30.6%). Participants with MetS demonstrated significantly higher waist circumference, WrC, body mass index (BMI), blood pressure, serum triglycerides, fasting plasma glucose, insulin levels, and homeostasis model assessment of insulin resistance, alongside lower high-density lipoprotein-cholesterol (HDL-C) levels compared with those without MetS. In correlation analyses, WrC positively correlated with age, BMI, and various metabolic parameters, while it negatively correlated with HDL-C levels. Logistic regression analysis identified the pubertal stage and WrC as the strongest independent predictors of MetS. In the mid-pubertal group, a cutoff of 1.795 (96.2nd percentile) for the WrC z-score effectively predicted MetS in children with obesity. In the post-pubertal group, a cutoff of 1.805 (96.7th percentile) for the WrC z-score effectively predicted MetS in children with obesity. Participants with increased WrC presented significantly higher rates of hypertension and MetS in both the mid-pubertal and post-pubertal groups. Conclusions: This study demonstrates that WrC is significantly elevated in children with obesity diagnosed with MetS compared with their non-MetS counterparts. Furthermore, findings indicate that mid-pubertal and post-pubertal subjects with increased WrC are at a greater risk of presenting CMR factors than those with normal WrC values.

The Role of Serum Free Fatty Acids in Endothelium-Dependent Microvascular Function

BACKGROUND

Elevated serum free fatty acid (FFA) concentration is associated with insulin resistance and is a hallmark of metabolic syndrome. A pathological feature of insulin resistance is impaired endothelial function.

OBJECTIVE

To investigate the effect of FFA reduction with either acipimox, a nicotinic acid derivative that impairs lipolysis, or salsalate, a salicylate that reduces basal and inflammation-induced lipolysis, on insulin-mediated endothelium-dependent vasodilation.

METHODS

This was a post hoc, combined analysis of two randomised, double-blind, placebo-controlled crossover trials. Sixteen subjects were recruited (6 with metabolic syndrome and 10 controls) and randomised to acipimox 250 mg orally every 6 h for 7 days or placebo. Nineteen subjects were recruited (13 with metabolic syndrome and 6 controls) and randomised to receive salsalate 4.5 g/day for 4 weeks or placebo. The primary outcome was the association between FFA concentration and insulin-mediated vasodilation, measured by venous-occlusion strain-gauge plethysmography at baseline and following FFA modulation with the study drugs.

RESULTS

At baseline, FFA concentration (R = -0.35, p = 0.043) and insulin sensitivity (HOMA-IR: R = -0.42, p = 0.016, Adipo-IR: R = -0.39, p = 0.025) predicted insulin-mediated vasodilation. FFA levels were significantly reduced after drug pretreatment (0.604 vs. 0.491 mmol/L, p = 0.036) while insulin levels, insulin sensitivity and inflammatory markers were unchanged. Despite a reduction in circulating FFA with drug therapy, neither insulin-stimulated vasodilation nor insulin sensitivity improved.

CONCLUSIONS

Short-term reduction of FFA concentration does not improve insulin-stimulated vasodilation in patients with metabolic syndrome.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00759291 and NCT00760019 (formerly NCT00762827).

Individuation of a cut-off value of triglyceride-glucose index for incident diabetes mellitus in patients with essential hypertension

The prevalence of obesity and diabetes, risk factors for atherosclerotic vascular diseases, is increasing worldwide; therefore, it is desirable to early identify them to reduce cardiovascular events. Thus, we investigated whether the triglyceride-glucose index (TyG index), a new marker of insulin resistance, is associated with incident diabetes in patients with newly diagnosed arterial hypertension. We selected 585 patients with newly diagnosed arterial hypertension referred to our tertiary Clinic of Catanzaro University Hospital for the evaluation of their cardiometabolic risk profile. None of the patients had diabetes mellitus at enrollment and took any drug known to affect glucose metabolism. Patients underwent medical history collection, clinical examination and laboratory tests. The TyG index was calculated as the ln [fasting TG (mg/dl) × FPG (mg/dl)/2], as previously suggested. During the follow-up [mean 8.5 years (range 3.1-10.7)], there were 78 new cases of incident diabetes (1.57% patient-year). Patients who developed diabetes mellitus were older and had a higher body mass index (BMI), baseline blood pressure, fasting glucose, insulin, homeostatis model sssessment (HOMA) index, triglyceride, creatinine and hs-CRP mean values, while estimated glomerular filtration rate values were lower. At the Cox regression analysis, covariates significantly associated with incident diabetes were: BMI (HR = 2.842, 95%CI = 2.299-3.514), TyG index (HR = 2.392, 95%CI = 1.745-3.192), age (HR = 1.944, 95%CI = 1.527-2.474), hs-CRP (HR = 1.409, 95%CI = 1.153-1.722), and HOMA (HR = 1.325, 95%CI = 1,079-1.756). The best estimated cut-off value of TyG index in predicting diabetes was 4.71. In addition, we documented a significant relationship between TyG index and HOMA (r = 0.575; p < 0.0001). Present data demonstrate that TyG index, a simple and cost-effective marker of insulin resistance, is useful in predicting incident diabetes in patients with arterial hypertension.

Perspectives on the profiling of renal risk in obesity

With the formal designation of obesity as a primary disease process, early detection of its end-organ consequences and the prognostication of long-term risk will become an important aspect of its clinical management. Obesity is increasingly recognized as a treatable risk factor for chronic kidney disease. However, profiling of kidney health and estimation of renal risk remain relatively underemphasized in obesity and nephrology care guidelines. The establishment of clinical protocols that facilitate the detection of early-stage renal impairment in obesity and incorporate profiling of an individual's risk of progression, could help guide strategies to break the causal association between obesity and chronic kidney disease. Currently, checks on kidney health in patients with obesity are prompted due to the presence of obesity complications such as cardiovascular and/or metabolic disease and routine screening relies upon the use of estimated glomerular filtration rate equations. Ample evidence exists to demonstrate that these equations are of limited utility in the setting of excess body weight and intentional weight loss. The present article presents the case that an expanded model of renal risk profiling should be developed for obesity medicine, suggesting feasible means of incorporating important risk factors and biomarker profiling alongside a more targeted assessment of directly measured GFR and renal functional reserve in at risk patients. The development of such a model or variation thereof should be prioritized to guide the targeted deployment of obesity treatments with proven reno-protective effects.

Impact of Meal Frequency on Insulin Resistance in Middle-Aged and Older Adults: A Prospective Cohort Study

BACKGRUOUND

Insulin resistance (IR) is central to metabolic disorders and significantly influenced by diet. Studies on meal frequency (MF) and metabolic indicators have shown mixed results. This study explores the link between MF and IR in middle-aged and older adults.

METHODS

This prospective cohort study included 4,570 adults aged 40 to 69 years from the Korean Genome and Epidemiologic Study. MF were divided into two groups based on whether they consumed three or more, or fewer than three, meals daily. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR); participants were classified as IR if their HOMA-IR value was ≥2.5. Multiple Cox proportional hazard regression analyses were conducted to examine the association between MF and the incidence of IR.

RESULTS

After adjusting for all variables, individuals in the MF ≥3 group showed a reduced incidence of IR compared to those in the MF <3 group (hazard ratio, 0.880; 95% confidence interval, 0.782 to 0.990). Additionally, subgroup analyses by sex, diabetes mellitus (DM), and body mass index (BMI) showed that this association persisted only in men, individuals without DM, and those with a BMI <25.

CONCLUSION

Our findings indicate that a higher MF among middle-aged and older adults is associated with a reduced incidence of IR. However, this association was maintained only in men, individuals without DM, and those without obesity.

Investigating the role of dietary glycemic factors and antioxidant capacity, metabolic status, and oxidative stress in seborrheic dermatitis: A case-control study

BACKGROUND

The etiopathogenesis of seborrheic dermatitis (SD) remains unexplained, although several factors have been considered in this regard.

OBJECTIVE

The aim of this study is to investigate diet, metabolic status, and oxidative stress in SD patients.

METHODS

This prospective, single-center, case-control study included 49 SD patients and 40 gender- and age-matched healthy controls.

RESULTS

Dietary total antioxidant capacity values were significantly lower in SD patients than among the controls (7.16 ± 2.66 vs 12.85 ± 4.26; P < .001). Glycemic load (GL) values were significantly higher in SD patients (187.2 ± 57.2 vs 110.6 ± 46.5; P < .001). The glycemic index and GL values of patients with severe SD were significantly higher than those with mild SD (P = .014, P = .017; respectively).

LIMITATIONS

The cross-sectional design, small sample size, and the relatively short duration of questioning dietary habits are the limitations of the study.

CONCLUSION

A diet rich in antioxidants and with low glycemic index/GL content may be beneficial in the treatment of SD.

Effects of four-weeks porcine-collagen hydrolysate consumption on glucose concentrations, glycemic variability, and fasting/postprandial cardiometabolic risk markers in men and women with overweight or obesity: A randomized, controlled trial

BACKGROUND

Different collagen hydrolysate sources have reduced fasting glucose concentrations. Although porcine-derived collagen hydrolysate predicts in vitro the highest potency for improving glucose metabolism, these effects have not been studied in humans.

AIM

To evaluate the effects of porcine-derived collagen hydrolysate on continuously monitored glucose concentrations in real-life conditions in individuals with overweight/obesity. Additionally, postprandial responses following a mixed meal test were examined.

METHODS

Fifty-six men and women participated in this randomized placebo-controlled parallel trial. After a two-week run-in period, participants consumed daily for four weeks 10 g porcine-derived collagen hydrolysate or placebo (erythritol). The primary outcome parameter was the interstitial glucose area under the curve (AUC) during daytime (07:00 to 22:00) measured during three consecutive days. In addition, glycemic variability (GV) was quantified. For this, a continuous glucose monitor (Freestyle Libre ProiQ, Wiesbaden, Germany) was used at the end of the run-in and intervention periods. Postprandial glucose, insulin, and triacylglycerol concentrations were also evaluated after a mixed meal tolerance test. Furthermore, fasting glucose, insulin, hemoglobin A1c (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), HOMA of β-cell function (HOMA-β), and triacylglycerol changes were analyzed. Physical activity profiles and dietary intakes were monitored to exclude confounding by these lifestyle factors.

RESULTS

Collagen hydrolysate consumption did not significantly affect daytime interstitial glucose AUC concentrations (95%CI for the effect size: -5.1, 30.0 mmol/(L∗h); p-value = 0.159), but increased several GV metrics: standard deviation (95%CI: 0.0, 0.2 mmol/L; p-value = 0.011), continuous overall net glycemic action (CONGA-4) (95%CI: 0.1, 0.4 mmol/L; p-value = 0.015), coefficient of variation (95%CI: 0.1, 3.0 %; p-value = 0.036), M-value (95%CI: 0.2, 1.8; p-value = 0.036), and mean amplitude of glycemic excursions (MAGE) (95%CI: 0.2, 1.8 mmol/L; p-value = 0.036). Furthermore, the postprandial glucose AUC after the mixed meal test significantly increased (95%CI: 0, 103 mmol/L∗4-h; p-value = 0.049), as well as fasting insulin concentrations (p-value = 0.005), HOMA-IR (p-value = 0.008), and HOMA-β (p-value = 0.009). Other parameters, anthropometrics, physical activity, and energy/nutrient intakes were not significantly changed.

CONCLUSION

Four-week collagen hydrolysate intake did not change free-living glucose concentrations, but increased GV, postprandial glucose AUC, fasting insulin, HOMA-IR, and HOMA-β. However, these changes were small with limited clinical relevance. Therefore, it can be concluded that this porcine-derived collagen hydrolysate does not improve glucose metabolism or other cardiometabolic risk markers.

CLINICAL TRIAL REGISTRATION

This clinical trial was registered in November 2021 as NCT05282641.

Patterns of Dietary Fatty Acids and Fat Spreads in Relation to Blood Pressure, Lipids and Insulin Resistance in Young Adults: A Repeat Cross-Sectional Study

Background/Objectives: Determining whether dietary fatty acids and the use of fat spreads are associated with cardiovascular risk factors is difficult due to the multicollinearity of fatty acids and the consumption of multiple spread types. Methods: We applied clustering methodologies using data on 31 different fatty acids and 5 different types of fat spreads (high fat: butter, blended butters, and margarines; lower fat: polyunsaturated and monounsaturated) and investigated associations with blood pressure, serum lipid patterns and insulin resistance in the Raine Study Gen2 participants in Western Australia, at 20 and 22 years of age. Results: Amongst n = 785 participants, there were eight distinct clusters formed from the fatty acid data and ten distinct clusters formed from the fat spread data. Male participants had higher systolic blood pressure than females (122.2 ± 11.6 mmHg versus 111.7 ± 10.3, p < 0.001 at age 20 and 123.4 ± 10.6 versus 113.9 ± 9.8, p < 0.001 at age 22). Males consuming exclusively butter as a fat spread had significantly higher SBP (+4.3 mmHg) compared with males not using spreads. Males consuming a high intake of margarine had significantly higher SBP (+6.6 mmHg), higher DBP (+3.4 mmHg) and higher triglycerides (+30.5%). Amongst females, four patterns of fatty acid intake were associated with lower levels of HDL cholesterol compared with the low-saturated-fat/high n-3 reference group (p = 0.017 after adjustment for relevant confounders, range = -10.1% to -16.0%, p = 0.017). There were no associations between clusters and HOMA-IR or other serum lipids for males or females. Conclusions: Compared to using no fat spreads, amongst males, a high intake of margarine was characterised by higher systolic and diastolic blood pressure and higher serum triglycerides, whilst the use of butter also was associated with higher SBP. Diets low in n-3s or high in trans fats were associated with sub-optimal HDL levels amongst females.

The association between insulin resistance and QT interval: A systematic review and Meta-Analysis

BACKGROUND

Insulin resistance (IR) is a major health concern associated with various diseases, and prolonged QT interval can potentially lead to life-threatening arrhythmias and death. There are conflicting views on the relationship between IR and QT interval. This meta-analysis aims to comprehensively investigate the association between IR and QT interval.

METHODS

An extensive search in databases PubMed, Scopus, Cochrane Library, Embase, and Web of Science up to October 2024 was conducted. Cohort studies which reported means and standard deviations for the QTc interval across the case and control groups with and without insulin resistance based on HOMA-IR were eligible for inclusion. Research with partial or inaccessible primary data, those involving participants with pre-existing cardiac conditions, and those with ambiguous results were excluded. The evaluation of study quality utilized the Newcastle-Ottawa Scale. A random-effects model was applied for the meta-analysis, and Egger's test was used to assess publication bias. GRADEproGDT was used to evaluate the certainty of the evidence.

RESULTS

Five studies, encompassing 603 participants, met the inclusion criteria. A significant positive association was observed between IR and QT interval (Weighted Mean Difference [WMD] = 12.38, 95% Confidence Interval [CI]: 5.51, 19.25). All included studies demonstrated high methodological quality. Assessment for publication bias revealed no significant findings (p-value for Egger's test = 0.39). The quality of evidence for the main outcome was moderate. Subgroup analyses revealed a significant link between IR and QT interval in studies from Turkey and India, with samples over fifty, and involving adults.

CONCLUSIONS

This meta-analysis highlights that IR is linked to an elevated risk of QT prolongation. Early identification of IR is crucial to mitigate the risk of QT prolongation and subsequent arrhythmias, thus emphasizing the importance of early intervention to prevent adverse cardiac outcomes and sudden cardiac death. Caution is needed when interpreting our results due to study heterogeneity, certainty of evidence, and sensitivity analysis findings. More rigorous research on this subject is required.

Sex-specific optimal cut-off points for metabolic health indicators to predict incident type 2 diabetes mellitus

BACKGROUND AND AIM

We aimed to determine the optimal cut-off points for metabolic health indicators, including insulin resistance (IR), glucose, insulin, BMI, and waist circumference, in middle-aged nondiabetic people to predict future type 2 diabetes mellitus (T2DM).

METHODS AND RESULTS

The data came from 12,543 Atherosclerosis Risk Communities Study participants, including 5758 men and 6785 women. They did not have diabetes at baseline and were followed for incident T2DM within 3, 6, and 9 years. IR was estimated using four IR metrics: HOMA-IR, METS-IR, TyG index, and TG/HDL-C. We used the Youden index to determine the optimal cut-off values. In females, the cut-off points for glucose to predict incident T2DM ranged from 96 to 102 mg/dL, with Area Under the Curve (AUC) values of 0.64-0.85. In males, the cut-off points ranged from 102 to 106 mg/dL, with AUC values of 0.60-0.83. For HOMA-IR, the cut-off points in females varied from 2.4 to 3.2, with AUC values of 0.69-0.78, while they ranged from 2.8 to 3.2 in males. The optimal cut-off values for METS-IR, TyG index, TG/HDL-C, insulin, BMI, and waist circumference were 40-43, 8.6-8.9, 2.0-3.2, 9-15 μU/mL, 28-29 kg/m2, and 91-97 cm in women, and 44-45, 8.8-8.9, 2.9-3.2, 11-12 μU/mL, 27-29 kg/m2, and 99-103 cm in men.

CONCLUSIONS

The optimal threshold for each predictor's prediction of incident T2DM varied by sex. The eight predictors' order of predictive performance were fasting glucose, HOMA-IR, METS-IR, insulin, BMI, waist circumference, TyG index, and TG/HDL-C.

Short- to medium-term follow-up of normoponderal children and adolescents with subclinical hypothyroidism: a retrospective study of the last 15 years

OBJECTIVES

Subclinical hypothyroidism (SCH) is defined by elevated thyroid-stimulating hormone (TSH) levels (>5 mUI/L) and normal total and free thyroxine levels (fT4). There is ongoing debate over whether mild SCH should be treated. This study aims to assess the clinical course of normoponderal pediatric patients with SCH.

METHODS

Retrospective study, involving normoponderal children and adolescents with SCH, followed at the Pediatrics Department of Hospital de Braga, from December 2007 to December 2022.

RESULTS

We identified 47 children and adolescents with confirmed SCH. No sex predominance was found. The median age at diagnosis was 11 years. Most cases were idiopathic (59.6 %) and diagnosed during puberty (57.5 %). The majority (46.8 %) experienced spontaneous remission, while 38.3 % required levothyroxine (LT) therapy. Discharged patients were followed for a median of 25 months. No significant differences were seen in body mass index z-score, fT4 levels, heart rate, blood pressure, or lipid parameters. Significant differences were found in thyroid-stimulating hormone (TSH) levels and LT dosage. Thyroid peroxidase antibody (TPOAb) positivity was significantly correlated with SCH's natural history. Although initial TSH levels were not significantly associated with SCH's natural course, they predict treatment need. Individuals with initial TSH levels >6.47 mUI/L were more likely to require therapy. In the third year of follow-up, a significant strong negative correlation was found between TSH levels and high-density lipoprotein cholesterol.

CONCLUSIONS

SCH was self-limiting and benign in most cases. TPOAb positivity was a predictor of SCH's natural history, and the need for treatment was predicted by initial TSH levels.

Intermittent fasting regulates gut microbiota and serum metabolome profiles in middle-aged mice fed high-fat diet

BACKGROUND

Intermittent fasting (IF) has received wide attention as an effective diet strategy. Existing studies showed that IF is a promising approach for weight control, improving insulin sensitivity and reducing type 2 diabetes mellitus (T2DM) prevalence.

METHODS

Twenty-eight 8-month-old male C57BL/6J mice were randomly divided into a normal control group (NC), a high-fat diet group (HFD) and an HFD + IF group. Body weight (BW) and food intake were monitored weekly. After 20 weeks, the intraperitoneal glucose tolerance test (IPGTT), oral glucose tolerance test (OGTT), and intraperitoneal insulin tolerance test (IPITT) were performed weekly in sequence. Fresh faeces were collected to examine changes in gut microbiota, and serum untargeted metabolite profiling was conducted on serum samples.

RESULTS

IF significantly reduced weight gain, fat mass and liver weight, improved glucose tolerance and insulin sensitivity in middle-aged mice fed with high-fat diet. 16 S rRNA gene sequencing revealed that IF significantly reduced the Firmicutes/Bacteroidetes (F/B) ratio by increased Muribaculaceae, Bacteroides, Parabacteroides, and decreased Bilophila, Colidextribacter, Oscillibacter. The serum untargeted metabolomics revealed that IF could modulate differential metabolites and metabolic pathways associated with glycolipid metabolism. Spearman's correlation analysis indicated that key differential microbiota were strongly correlated with glucose metabolism-related indicators and serum metabolites such as stearic acid, obeticholic acid, and N-acetylglycine.

CONCLUSIONS

IF improves glucose metabolism, regulates gut microbiota, and alters serum metabolites in middle-aged mice fed a high-fat diet. This provides a new pathway for trials testing diabetes prevention in middle-aged and elderly patients.

Decreased Homeostasis Model Assessment of β-Cell Function in Patients Without Diabetes Can Predict Future Events in Patients With Cardiovascular Disease

BACKGROUND

Reduced insulin secretion is linked to diabetes and cardiovascular disease (CVD), but its role in non-diabetic CVD patients is unclear. The homeostasis model assessment of β-cell function (HOMA-β) measures pancreatic β-cell function. This study investigated the association between HOMA-β and adverse cardiovascular events in non-diabetic CVD patients.

METHODS AND RESULTS

This study included 1301 non-diabetic CVD patients who underwent cardiac catheterization at the University of Yamanashi Hospital. HOMA-β was calculated based on fasting blood glucose and insulin levels. Patients were followed for 3 years to track adverse events, such as all-cause death, myocardial infarction, angina pectoris requiring percutaneous coronary intervention, and heart failure. Receiver operating characteristic curve analysis established a HOMA-β cut-off value of ≤49.3%. Kaplan-Meier analysis indicated that patients with HOMA-β ≤49.3% had a significantly higher risk of adverse events (P <0.001), with a 2.65-fold increased risk (hazard ratio 2.65; 95% confidence interval 1.97-3.57). Adding HOMA-β to traditional risk factors such as age, sex, estimated glomerular filtration rate, and left ventricular ejection fraction significantly improved risk prediction, as demonstrated by net reclassification improvement and integrated discrimination improvement.

CONCLUSIONS

Decreased HOMA-β is a significant predictor of adverse cardiovascular events in CVD patients without diabetes. These findings suggest reduced insulin secretion contributes to worse outcomes, underscoring the importance of monitoring HOMA-β in this population.

Adiponectin and Leptin-Considerations in Adult Patients with Spinal Muscular Atrophy Type 3

Background: Spinal muscular atrophy (SMA) is a severe neuromuscular disorder characterized by the degeneration of alpha motor neurons in the spinal cord, leading to progressive proximal muscle weakness and paralysis. SMA is clinically categorized into four phenotypes based on age of onset and motor function achieved. Patients with SMA type 3 (juvenile, Kugelberg-Welander disease) initially have the ability to walk unaided, but experience a gradual decline in motor abilities over time. However, their lifespan is not affected by the presence of the disease. Leptin, a cytokine-like hormone secreted by adipocytes, has receptors widely distributed in musculoskeletal tissues. Several studies suggest that adiponectin deficiency contributes to the development of insulin resistance, with lower adiponectin levels closely associated with greater insulin resistance and hyperinsulinemia. However, the role of adiponectin in different types of sarcopenia and its connection to insulin sensitivity remains controversial. The purpose of this study was to measure leptin and adiponectin levels in patients with SMA type 3 and explore their association with markers of insulin sensitivity. Methods: This cross-sectional study included 23 adult patients with SMA type 3 (SMA group) and 18 community-based healthy volunteers (control group), conducted from July 2020 to September 2024. Anthropometric parameters, body composition, body fat percentage, surrogate markers of insulin sensitivity (Homeostasis model assessment of insulin resistance index-HOMA-IR and ISI Matsuda), and circulating levels of leptin and adiponectin were measured in all participants. Results: Insulin resistance was present in 91.3% of patients with SMA type 3, as determined by HOMA-IR and ISI Matsuda insulin sensitivity markers. In the control group, 64.7% had insulin resistance (IR) according to HOMA-IR, while 44.4% met the ISI Matsuda criterion for IR, showing a significant difference in peripheral insulin sensitivity between groups. A significant difference in serum adiponectin levels was observed between patients with SMA type 3 and the control group, whereas there was no significant difference in serum leptin concentrations. High adiponectin levels were observed in 50% of patients with SMA type 3. In the healthy control group, adiponectin levels positively correlated with ISI Matsuda and negatively correlated with HOMA-IR, confirming the insulin-sensitizing role of adiponectin. However, this correlation was not observed in patients with SMA type 3. Conclusions: Our results suggest that in this specific type of hereditary neuromuscular disease, the interplay between sarcopenia and insulin leads to adiponectin resistance, challenging the canonical narrative between insulin sensitivity and adiponectin, and indicating a need for further research.

The Association Between Epicardial Adipose Tissue Thickness and the Triglyceride-glucose Index in Prediabetic Obese Patients

Obesity and pre-diabetes are metabolic disorders associated with insulin resistance (IR). Excess epicardial adipose tissue is also associated with increased IR. The triglyceride-glucose index (TyG) has been evaluated as an alternative measure of the IR in a variety of metabolic and cardiovascular disorders. However, its relationship with EAT thickness has not been studied yet. The study included 176 prediabetic and obese patients. EAT thickness was assessed using echocardiography. EAT thickness, TyG index, anthropometric obesity indices (body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR)), homeostatic model assessment (HOMA-IR), and biochemical parameters were compared. The following correlations between EAT thickness and related parameters were observed: WC (r = .529), BMI (r = .514), ALT (r = .358), TyG index (r = .338), and HOMA-IR (r = .322; P < .001 for all). Multiple regression analysis showed that WC (Beta = .428; P = .004), age (Beta = .223; P < .001), BMI (Beta = .196; P = .029), ALT (Beta = .168; P = .012), and TyG index (Beta = .128; P = .049) were the strongest independent variables correlated with EAT thickness. A model based on WC, BMI, age, TyG index, and ALT provided the best R-square (.387) for estimating EAT thickness (P < .001). The TyG index showed a significant and independent relationship with EAT, suggesting that it may be useful as an indicator of EAT thickness.

Associations between religiosity/spirituality with insulin resistance and metabolic syndrome in the Midlife in the United States (MIDUS) study

Religiosity and spirituality (R/S) are central aspects to the lives of many people worldwide. Previous research suggests a potentially beneficial relationship between R/S, mostly understood as religious service attendance, and mortality. Though important, this research often fails to account for the complex and multidimensional nature of R/S. Also lacking is an adequate understanding of the physiological mechanisms that may link R/S with mortality and other health outcomes. Insulin resistance and metabolic syndrome, subclinical physiological processes that are influenced by the types of lifestyle factors and psychological factors that R/S addresses, serve as two possible biological mechanisms linking R/S and health outcomes. This study investigated the relations of R/S, defined as service attendance, support from one's religious community, and composite variables comprised of several diverse R/S indicators, in relation to insulin resistance and metabolic syndrome both cross-sectionally and in longitudinal analyses across 8-10 years in the Midlife in the United States (MIDUS) study. Results, controlling for important covariates (demographic factors, self-rated health, chronic conditions, depressive symptoms for all analyses; diabetes status and body mass index for insulin resistance analyses; antihyperlipidemic medications for metabolic syndrome), demonstrated nonsignificant relationships for all measures of R/S and both insulin resistance and metabolic syndrome in both cross-sectional and longitudinal analyses. Integrating these findings into the limited research on physiological mechanisms in the R/S and health relationship suggests that the area lacks consistent findings. Additional studies that use heterogenous, representative samples and further refine the operationalization of R/S are indicated.

Novel bioactive peptides alleviate Western diet-induced MAFLD in C57BL/6J mice by inhibiting NLRP3 inflammasome activation and pyroptosis via TLR4/NF-κB and Keap1/Nrf2/HO-1 signaling pathways

Metabolic-associated fatty liver disease (MAFLD) has emerged as a leading chronic liver disease. This condition is characterized by an abnormal accumulation of fat within liver and can progress from simple steatosis to more severe stages involving chronic inflammation and oxidative stress. In this study, we investigated the potential therapeutic effects and underlying mechanism of novel bioactive peptides (EWYF and EWFY) on Western diet-induced MAFLD in C57BL/6J mice. Mice fed a normal chow diet (ND group) and Western diet (WD and treatment groups) for 8 weeks. Treatment groups received EWYF and EWFY peptides in low (10 mg/kg/day) and high (50 mg/kg/day) doses were divided into four groups: EWYF10, EWYF50, EWFY10, and EWFY50. Western diet-induced body weight gain and increased liver weight along with visceral adiposity, which were markedly reversed by bioactive peptides in a dose-dependent manner. Additionally, bioactive peptides significantly reduced hepatic steatosis, liver injury and proinflammatory response. Western diet-induced glucose tolerance and insulin resistance, whereas bioactive peptides significantly improved glucose tolerance and insulin sensitivity. Persistent intake of Western diet triggered chronic inflammation and severe oxidative stress, which were significantly alleviated by bioactive peptides treatment via inhibiting NOD-like receptor protein 3 (NLRP3) inflammasome activation and mitigated pyroptosis by modulating TLR4/NF-κB and Keap1/Nrf2/HO-1 signaling pathways. Furthermore, molecular docking studies suggest that EWYF and EWFY act as fructokinase antagonists and TLR4 inhibitors, which potentially alleviates Western diet-induced MAFLD. Collectively, these findings highlight EWYF and EWFY as promising candidates for MAFLD treatment due to their potent antioxidant and anti-inflammatory properties via specific molecular inhibition.

Association of insulin resistance surrogates with disease severity and adverse outcomes in chronic thromboembolic pulmonary hypertension: a multicenter cohort study

BACKGROUND

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severely progressive disease that leads to right heart failure and death. Previous studies have shown that diabetes and insulin resistance (IR) are closely related to pulmonary hypertension, but the role of IR in patients with CTEPH remains unexplored. In this study, we investigated the relationship between four insulin resistance indices and disease severity, hemodynamic parameters, and adverse outcomes in patients with CTEPH.

METHODS

We conducted a multicenter, retrospective cohort study involving 516 patients diagnosed with CTEPH between January 2013 and December 2022. The metabolic score for IR (METS-IR), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose (TyG) index, and triglyceride-glucose-body mass (TyG-BMI) index were used to quantify IR levels in patients with CTEPH. The primary endpoint events were clinical worsening. Multivariable Cox regression, restricted cubic splines, and receiver operating characteristic analyses were used to evaluate the predictive value of surrogates for IR.

RESULTS

Compared with in low to intermediate-low risk patients, the METS-IR (36.2 ± 6.7 vs. 37.7 ± 8.7, p = 0.038) and TyG-BMI index (204.0 ± 36.2 vs. 212.6 ± 46.5, p = 0.022) were significantly increased in high to intermediate-high risk patients. METS-IR correlated with markers of disease severity, such as World Health Organization functional class, 6-minute walk distance, and N-terminal pro-brain natriuretic peptide levels. During a mean of 2.5 years' follow-up, 110 participants experienced all-cause death or worsening condition. METS-IR independently predicted clinical worsening (hazard ratio: 1.27; 95% confidence interval 1.06-1.53 per 1.0-standard deviation increment, p = 0.009) after fully adjusting for covariates. Adding METS-IR to the COMPERA 2.0 risk score significantly improved its predictive ability, reclassification and discrimination ability.

CONCLUSIONS

METS-IR is an independent predictor of clinical worsening in patients with CTEPH. It offers a convenient marker for assessing disease severity and long-term outcomes in clinical risk assessment.

Associations of estimated glucose disposal rate with frailty progression: results from two prospective cohorts

BACKGROUND

Frailty is a common geriatric syndrome associated with many adverse health outcomes. Identifying the risk factors of frailty is crucial and the insulin resistance (IR) is considered as a potential target. The estimated glucose disposal rate (eGDR) is a simple and reliable surrogate marker of IR. Associations of eGDR with frailty have not been explored. This study aimed to investigate the associations of eGDR with frailty progression.

METHODS

We used data from two prospective cohorts of the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The eGDR was calculated as follows: eGDR (mg/kg/min) = 21.158 - (0.09×waist circumference) - (3.407×hypertension) - (0.551×glycosylated hemoglobin A1c) [waist circumference (cm), hypertension (yes = 1/no = 0), and glycosylated hemoglobin A1c (%)]. Participants were divided into three categories by tertiles of eGDR. Frailty index (FI) was calculated every two years and used to assess the degree of frailty which ranged from 0 to 100. Frailty progression was assessed by repeated measurements of FI during follow-up. Linear mixed-effect models were used to analyze the associations of eGDR with frailty progression.

RESULTS

8872 participants from CHARLS (mean age: 58.9 years, female: 53.3%) and 5864 participants from HRS (mean age: 67.0 years, female: 59.0%) were included. The median follow-up periods were 7.0 years in the CHARLS and 12.8 years in the HRS, respectively. Compared to participants with lower tertile (T1) of eGDR, those with upper tertile (T3) of eGDR showed decelerated FI progression (CHARLS, β: -0.294, 95%CI -0.390 to -0.198, P < 0.001; HRS, β: -0.378, 95%CI -0.474 to -0.281, P < 0.001). Continuous eGDR was also associated with FI progression for significant deceleration in FI progression with per 1 SD increase in eGDR (CHARLS, β: -0.142, 95%CI -0.181 to -0.103, P < 0.001; HRS, β: -0.170, 95%CI -0.209 to -0.130, P < 0.001). These associations were still observed after excluding baseline frail participants. Furthermore, the associations of eGDR with FI progression were consistent among participants with and without diabetes.

CONCLUSION

Regardless of diabetes or not, a higher level of eGDR was associated with the decelerated frailty progression. Our findings highlight the role of eGDR in frailty progression and recommend taking effective interventions to improve eGDR for preventing frailty progression.

Insights Into Non-Alcoholic Fatty Liver Disease and Diabetes Mellitus in Somalia: Prevalence and Risk Factors

Introduction

NAFLD is a rapidly expanding global health issue that is distinguished by the accumulation of hepatic fat that is not associated with alcohol consumption. Parallel to the increase in obesity and type 2 diabetes mellitus (T2DM), its prevalence is also increasing. Amidst a backdrop of limited epidemiological data, Somalia, which is undergoing urbanization and dietary adjustments, is contending with escalating rates of NAFLD. Our study aims to addresses critical voids in local epidemiological data regarding this subject in Somalia.

Methods and Materials

The objective of this retrospective study was to evaluate the prevalence of NAFLD and concomitant risk factors among T2DM patients at the Mogadishu Somalia Turkish Training and Research Hospital. A total of 832 patients diagnosed with T2DM between May 2023 and March 2024 were used to analyze the data. Various variables, such as age, sex, diabetic medications, hypertension, insulin resistance, hyperlipidemia, and NAFLD grade, were obtained from electronic medical records. Statistical analyses were conducted to investigate the associations and predictors of NAFLD using descriptive analysis, logistic regression, and multiple regression.

Results

The study cohort was predominately female (57%), with a mean age of 53.48 years. The most prevalent grades of NAFLD were grade 1 and grade 2, with NAFLD being identified in 53.8% of patients. NAFLD displayed a robust correlation with insulin resistance (OR: 52.04), with hypertension (OR: 20.091) and hyperlipidemia (OR: 2.528) following shortly thereafter. These factors collectively account for 57% of the variance in NAFLD, as indicated by multiple regression analysis (R2 = 0.57, F (6,823) = 184.302, p < 0.001).

Conclusion

This investigation emphasizes the presence of a high prevalence of NAFLD among T2DM patients in Mogadishu, Somalia, 53.8% which is substantially influenced by hypertension, insulin resistance, and hyperlipidemia. In this region, the necessity of targeted healthcare strategies to mitigate metabolic liver diseases is underscored by the results.

Differential levels of thyroid hormones, cortisol, and apolipoprotein M in fatty liver disease

OBJECTIVES

Non-alcoholic fatty liver disease (NAFLD), recently reclassified as metabolic dysfunction-associated fatty liver disease (MAFLD), can also manifest in patients classified as non-MAFLD who do not meet MAFLD criteria. The involvement of cortisol and thyroid hormones may play a role in the pathogenesis of FLD by modifying the metabolism of specific lipoproteins, particularly apolipoprotein M (Apo M). This study investigated cortisol and thyroid hormones levels and Apo M gene expression in white blood cells (WBCs) of individuals with MAFLD, non-MAFLD, and healthy controls.

METHODS

The serum and WBCs of the study subjects were collected from patients with FLD (n=99) including 58 MAFLD and 41 non-MAFLD and healthy individuals (n=23). To investigate the gene expression of Apo M and thyroid and cortisol hormones, qRT-PCR and ELISA methods were used, respectively.

RESULTS

The Apo M gene expression was significantly lower in FLD patients, both non-MAFLD, and MAFLD patients compared to the control group (p<0.05). Total T4 and TSH hormone levels in the MAFLD patients were significantly decreased and increased compared to the control group, respectively (p<0.05). The cortisol level was significantly elevated in the FLD and MAFLD patients compared to the control group (p<0.01).

CONCLUSIONS

Alterations in Apo M gene expression also cortisol and thyroid hormones levels in non-MAFLD patients were milder than MAFLD patients when compared to the control. Also, likely Apo M may be involved in FLD pathogenesis.

Exploring the TyG Index and the Homeostasis Model Assessment of Insulin Resistance as Insulin Resistance Markers: Implications for Fibromyalgia Management and Understanding-A Narrative Review

Fibromyalgia (FM) is a chronic musculoskeletal disease with a higher prevalence among women. To date, there has been no definitive laboratory or imaging assessment for FM, and hence, the diagnosis criteria for FM remained based on subjective assessment of symptoms with high overlap with other rheumatological disorders. Many patients with FM suffer from metabolic disorders leading to insulin resistance (IR). There have been several methods to assess IR, among which the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and the triglyceride-glucose (TyG) index have been used more frequently, with the latter being more available and cost-effective. As higher IR has been reported for patients with FM with various mechanisms, in this review, we sought to investigate the association between IR and FM using the current evidence. One of the possible underlying mechanisms of this association might be mitochondrial dysfunction and oxidative stress observed in IR conditions and its role in FM. Studies have also shown that IR indices are higher in patients with FM, compared to healthy controls, while higher HOMA-IR levels were also reported for higher severities of FM based on Fibromyalgia Impact Questionnaire-Revised (FIQR) scores. While these findings suggest the possible involvement of IR in FM pathophysiology and add to the value of IR measurement in FM clinical assessment, further large-scale studies are needed to establish a definitive causal association between them.

Impact of physical activity on physical function, mitochondrial energetics, ROS production, and Ca2+ handling across the adult lifespan in men

Aging-related muscle atrophy and weakness contribute to loss of mobility, falls, and disability. Mitochondrial dysfunction is widely considered a key contributing mechanism to muscle aging. However, mounting evidence positions physical activity as a confounding factor, making unclear whether muscle mitochondria accumulate bona fide defects with aging. To disentangle aging from physical activity-related mitochondrial adaptations, we functionally profiled skeletal muscle mitochondria in 51 inactive and 88 active men aged 20-93. Physical activity status confers partial protection against age-related decline in physical performance. Mitochondrial respiration remains unaltered in active participants, indicating that aging per se does not alter mitochondrial respiratory capacity. Mitochondrial reactive oxygen species (ROS) production is unaffected by aging and higher in active participants. In contrast, mitochondrial calcium retention capacity decreases with aging regardless of physical activity and correlates with muscle mass, performance, and the stress-responsive metabokine/mitokine growth differentiation factor 15 (GDF15). Targeting mitochondrial calcium handling may hold promise for treating aging-related muscle impairments.

Chemosensory and cardiometabolic improvements after a fasting-mimicking diet: A randomized cross-over clinical trial

Obesity is associated with a decrease in chemosensory perception acuity and increased disease risk, pointing to the need for feasible interventions that affect smell, taste, and cardiometabolic markers. Here, subjects with overweight/obesity are treated with six monthly cycles of a fasting-mimicking diet (FMD) lasting 5 days followed by a normal diet for the rest of the month to determine their effects on chemosensory function and cardiometabolic risk factors. Both arms of the 102 randomized cross-over trial participants indicate FMD-dependent improvements in a wide range of taste and smell chemosensory functions. The portion of hyposmic subjects is reduced from 38.1% at baseline to 6.4% at the end of 6 FMD cycles. FMD cycles also reduce cardiometabolic and inflammatory markers and drug use in diabetic patients. This trial provides evidence for the effect of periodic FMD cycles in improving chemosensory function while reducing cardiometabolic risk factors without requiring long-term lifestyle changes. The trial is registered at ClinicalTrials.gov (NCT04529161).

Metabolic Effects of Testosterone Added to Intensive Lifestyle Intervention in Older Men With Obesity and Hypogonadism

BACKGROUND

Whether testosterone replacement therapy (TRT) conveys additional cardiometabolic benefit to an intensive lifestyle therapy (LT) in older men with obesity and hypogonadism remains unclear.

OBJECTIVE

To determine whether TRT augments the effect of LT on metabolic outcomes in older men with obesity and hypogonadism.

DESIGN

Secondary analysis of a randomized, double-blind, placebo-controlled trial.

SETTING

Veterans Affairs Medical Center.

PARTICIPANTS

Eighty-three older (age ≥ 65 years) men with obesity (body mass index ≥ 30 kg/m2) and persistently low Am testosterone (< 10.4 nmol/L) associated with frailty.

INTERVENTIONS

LT (weight management and exercise training) plus either testosterone (LT + TRT) or placebo (LT + Pbo) for 6 months.

OUTCOME MEASURES

The primary outcome was change in glycated hemoglobin (HbA1c). Secondary outcomes included changes in other glucometabolic and lipid profile components, liver enzymes, inflammatory markers, and adipokines; subcutaneous, visceral, intramuscular, and hepatic fat; blood pressure; and metabolic syndrome score.

RESULTS

HbA1c decreased similarly in LT + TRT and LT + Pbo groups (-0.5 ± 0.1 vs -0.6 ± 0.1%, respectively; P = 0.35). While TRT showed no synergistic effect with LT on ameliorating secondary outcomes, it eliminated the augmentative effect of LT on high-density lipoprotein cholesterol concentration (5.4 ± 1.0 mg/dL in the LT + Pbo group vs 0.2 ± 1.1 mg/dL in the LT + TRT group, P = .01) and adiponectin levels (-408 ± 489 ng/mL in LT + TRT group vs 1832 ± 468 ng/mL in LT + Pbo group, P = .02).

CONCLUSION

In older men with obesity and hypogonadism, adding TRT for 6 months to LT does not result in further improved cardiometabolic profiles and could potentially blunt some of the metabolic benefits induced by LT.

Impact of segmental body composition on metabolic dysfunction-associated fatty liver disease in Chinese children

Purpose

This study aimed to assess the relationship between regional body composition and metabolic dysfunction-associated fatty liver disease (MAFLD) in Chinese children.

Methods

In this study, 1399 children aged 7-14 years were included. Liver steatosis was assessed using the controlled attenuation parameter (CAP) measured through Fibroscan. MAFLD is defined as the presence of liver steatosis along with either overweight/obesity, prediabetes/diabetes, or at least two metabolic index abnormalities. Regression analyses were applied to assess the relationship between regional body composition and MAFLD in children. Subgroup analyses were performed based on sex and weight.

Results

The participants had a mean age of 9 years, with 52.11% being boys. Among them, 134 (9.57%) were diagnosed with MAFLD, and 17 (1.22%) had severe fatty liver disease. We found an inverse correlation between the muscle percentage in each region and MAFLD, with the extremities demonstrating the most significant negative correlation (OR: 0.732; 95% CI: 0.634-0.844). Conversely, regional fat was positively associated with MAFLD, with the strongest correlation found in the upper limbs (OR: 3.104; 95% CI: 2.023-4.764). Subgroup analyses showed similar results.

Conclusion

The decrease in regional muscle percentage, particularly in the limbs, along with the increase in regional fat percentage, especially in the upper limbs, is associated with a higher probability of developing MAFLD in prepubertal children. Additional prospective studies are needed to strengthen and validate these findings.

Hypoglycemia and hyperinsulinemia induced by phenolic uremic toxins in CKD and DKD patients

Patients with end-stage renal disease have lower fasting plasma glucose and HbA1c levels, with significantly higher insulin levels. For a long time, it has been believed that this higher insulin level in renal failure is due to decreased insulin clearance caused by reduced renal function. However, here we reported that accumulation of the gut microbiota-derived uremic toxin, phenyl sulfate (PS) in the renal failure, increased insulin secretion from the pancreas by enhanced glucose-stimulated insulin secretion. Other endogenous sulfides compounds which accumulated as in the renal failure also increased glucose-stimulated insulin secretion from β-cell. With RNA-seq analyses and gene knock down, we demonstrated that insulin secretion evoked by PS was mediated by Ddah2. In addition, we also found that PS increased insulin resistance through lncRNA expression and Erk phosphorylation in the adipocytes. To confirm the relationship between PS and glucose metabolism in human, we recruited 2 clinical cohort studies (DKD and CKD) including 462 patients, and found that there was a weak negative correlation between PS and HbA1c. Because these trials did not measure fasting insulin level, we alternatively used the urinary C-peptide/creatinine ratio (UCPCR) as an indicator of insulin resistance. We found that PS may induce insulin resistance in patients with eGFR < 60 mL/min/1.73 m2. These data suggest that the accumulation of uremic toxins modulates glucose metabolism and induced insulin resistance in CKD and DKD patients. Considering HbA1c as a reflection of chronic hyperglycemia and UCPCR as a reflection of chronic hyperinsulinemia, our findings indicate that PS is negatively associated with hyperglycemia independent of CKD, and positively associated with hyperinsulinemia in DKD patients.

Serum levels of visfatin and vaspin in healthy and complicated pregnancies and their association with anthropometric measures of their offspring

BACKGROUND

Research into the mechanisms of growth control during birth and postnatal life has shown that adipose tissue regulates many physiological functions in the body by secreting adipokines. The aims of this study were to investigate the serum levels of visfatin and vaspin in healthy and unhealthy pregnant women and its relationship with their newborns' anthropometric measurements.

MATERIALS AND METHODS

A total of 82 pregnant women were included in this study with their respective newborn, healthy pregnant women (n = 30), with obesity (n = 26) and with gestational diabetes (GD) (n = 26). We assessed differences between groups with ANOVA or Kruskal Wallis and correlation between adipokines and anthropometric measurements of the newborn with Spearman correlation.

RESULTS

Visfatin serum concentrations were higher in umbilical cord serum of newborns from mothers with obesity (p = 0.006). Maternal visfatin correlated negatively with their newborn's anthropometric measurements (p < 0.05). Umbilical cord visfatin correlated positively with maternal weight and body mass index (p < 0.05). Umbilical cord vaspin correlated positively with fat mass (p = 0.036) and weight gain of infants (p = 0.046).

CONCLUSIONS

These adipokines may be significant in the development of elevated adiposity in newborns. Offspring form mothers with obesity or GD are at higher risk.

The role of telomere shortening in ambient ozone exposure-related insulin resistance

BACKGROUND

Ozone (O3) exposure and telomere shortening are associated with insulin resistance (IR). However, the role of telomere shortening in ambient O3 exposure-related IR is largely unclear.

METHODS

The Henan Rural Cohort recruited participants and performed a random forest method to estimate residential O3 concentration. IR was reflected by homeostasis model assessment-IR, quantitative insulin sensitivity check index, triglyceride and glucose index, etc. Generalized linear model, quantile regression model, and mediation effects analysis were utilized to assess the associations of O3 exposure and relative telomere length (RTL) with longitudinal IR markers and their change rates. Furthermore, the role of telomere homeostasis in O3-exposure-induced IR in vivo and in vitro experiments was verified.

RESULTS

O3 exposure was positively associated with longitudinal IR. The proportions of RTL mediated associations between O3 exposure and longitudinal IR markers ranged from 11.92 % to 60.36 %. O3-exposed mice exhibited a higher glucose load, upregulation of GSK-3β and G-6-Pase expression at mRNA levels, glycogen accumulation reduction, telomere shortening, and decreased telomerase reverse transcriptase activity relative to air-exposed mice. In vitro experiments reveal that overexpression of TERT in HepG2 cells up-regulated G-6-Pase mRNA expression level.

CONCLUSIONS

Impaired telomere homeostasis may be involved in O3 exposure-related IR via inhibition of glycogen synthesis and acceleration of gluconeogenesis and the specific mechanisms are still further elucidated.

The Effect of a Low-Glycemic Index Diet on Postprandial Hypotension in Individuals With Chronic Spinal Cord Injury: Results From a Pilot Study

Background

One in two individuals with spinal cord injury (SCI) experiences postprandial hypotension (PPH), a decline (>20 mm Hg) in systolic blood pressure (SBP) within 2 hours after eating. Consuming meals with a low glycemic index (GI) could prevent or lessen PPH.

Objectives

To determine the effect of a low-GI diet on PPH and postprandial glucose and insulin in individuals with chronic SCI (>1 year postinjury).

Methods

Eleven participants (6 males, 5 females; age 43 ± 11 years) with chronic SCI (C4-C7, 7; T4-T12, 4) took part in a randomized crossover study (low GI vs. high GI). On each occasion, BP, glucose, and insulin were measured in the fasted state and for 2 hours after consuming a breakfast meal (60% carbohydrate, 28% fat, 12% protein) in laboratory-controlled conditions. Participants wore an ambulatory BP monitor and continuous glucose monitor for 3 days at home, and consumed study meals that were macronutrient-matched across conditions.

Results

The maximum decrease in systolic blood pressure (SBP) following the laboratory-controlled breakfast meals tended to be lower in the low-GI (14 ± 12 mm Hg) compared to the high-GI (24 ± 25 mm Hg) diet (d = 0.52, P = .056). Serum glucose (P < .01) and insulin (P = .026) concentrations were lower at 30 minutes in the low-GI diet. In the home setting, peak glucose concentrations were lower after lunch (P = .011) and dinner (P < .01) in the low-GI diet.

Conclusion

A low-GI meal may be an effective solution to reduce the magnitude of PPH and peak glucose concentrations in individuals with chronic SCI.

Insulin Sensitivity and Muscle Loss in the Absence of Diabetes Mellitus: Findings from a Longitudinal Community-Based Cohort Study

Background/Objectives: Muscle loss is a serious complication in chronic disease patients, yet studies on long-term changes in muscle mass based on insulin sensitivity in the absence of diabetes mellitus are scarce. This community-based cohort study analyzed the longitudinal association between insulin sensitivity and muscle loss in middle-aged South Korean adults. Methods: This study included 6016 subjects (aged 40-65 years) from the Korean Genome and Epidemiology Study, conducted between 2001 and 2016. Fat-free mass, fat mass, body weight, and kidney function were assessed biennially. Subjects were categorized into four groups based on the composite (Matsuda) insulin sensitivity index (ISI) quartiles. The primary outcome was muscle loss, defined as a decline in fat-free mass of 10% or more from baseline. The secondary outcome was the occurrence of all-cause mortality. Results: During 69,480 person-years of follow-up, muscle loss occurred in 311 (5.2%) subjects. Multivariable Cox regression revealed a reverse-graded association between insulin sensitivity and muscle loss risk. Hazard ratios (95% confidence intervals) for the second, third, and highest ISI quartiles were 0.70 (0.51-0.94), 0.69 (0.50-0.95), and 0.65 (0.46-0.92), respectively, compared with the lowest quartile. Insulin sensitivity, however, was not significantly associated with all-cause mortality, though the mortality risk was higher in individuals with muscle loss. Conclusions: A reverse-graded relationship between insulin sensitivity and muscle loss risk was identified in middle-aged South Korean adults, with the lowest risk in the highest ISI quartile. These findings suggest that higher insulin sensitivity may reduce the risk of muscle loss.

Differential association of selenium exposure with insulin resistance and β-cell function in middle age and older adults

OBJECTIVE

To assess whether the role of selenium on pre-diabetes is differential by age, given comorbidities and decreased β-cell function in older adults.

RESEARCH DESIGN AND METHODS

We evaluated the cross-sectional association of blood selenium with the homeostatic model assessment for insulin resistance (HOMA-IR) and β-cell function (HOMA-β) in middle-aged (Aragon Workers Health Study [AWHS], N = 1186), and older (Seniors ENRICA [Study on Nutrition and Cardiovascular Risk in Spain]-2 [SEN-2], N = 915) diabetes-free adults. A subsample of participants from AWHS (N = 571) and SEN-2 (N = 603) had glucose and insulin repeated measurements for longitudinal analysis. We validated the cross-sectional dose-response associations in the 2011-2018 National Health and Nutrition Examination Survey (NHANES, N = 1317 middle age and N = 960 older) participants. Selenium was measured in whole blood with ICP-MS in AWHS, SEN-2 and NHANES.

RESULTS

The cross-sectional geometric mean ratios (95% confidence intervals) per two-fold selenium increase were 1.09 (1.01, 1.19) for HOMA-IR and 1.15 (1.06, 1.24) for HOMA-β in AWHS; and 1.13 (0.98, 1.31) and 1.03 (0.90, 1.18), in SEN-2. The cross-sectional dose-response associations were consistent in NHANES, with mostly increasingly positive trends for both HOMA endpoints in younger adults and a plateau at levels >~150 μg/L in older adults. The longitudinal dose-response consistently showed positive associations at high selenium dose for both HOMA endpoints in the younger, but not the older, study population.

CONCLUSIONS

Increased blood selenium was associated with increased insulin resistance and β-cell function in middle-aged, but not in older individuals, especially for β-cell function. The results suggest that selenium-associated insulin resistance might induce compensatory increased β-cell function at younger ages, being this compensatory capacity decreased with aging.

Effect of dietary glycemic index on insulin resistance in adults without diabetes mellitus: a systematic review and meta-analysis

Low glycemic index (LoGI) diets are associated with decreased insulin resistance and are an effective strategy for patients with diabetes mellitus to control postprandial glucose levels. However, whether these effects on insulin resistance and glucose levels are also observable in those without diabetes mellitus is poorly understood. The present study examined the influence of LoGI diets compared with that of high glycemic index (HiGI) diets on insulin resistance in adults without diabetes mellitus. This meta-analysis included six randomized controlled trials involving 192 participants with a mean age of 52.5 years. A homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated for each trial, and differences in HOMA-IR before and after each dietary intervention were calculated independently. The primary outcome was variations in insulin resistance, which was assessed by proxy as the difference between HOMA-IR scores at the beginning and end of the trials. The results suggested that LoGI diets decrease HOMA-IR scores to a greater extent than HiGI diets (estimate: 0.31; 95% confidence interval [CI], 0.01-0.61; p < 0.001) in individuals without diabetes mellitus. This association remained significant (estimate: 0.16; 95% CI, 0.01-0.31) after excluding one study with a short follow-up time (7 days). In conclusion, LoGI diets lower HOMA-IR scores to a greater extent than HiGI diets in adults without diabetes mellitus.

Systematic review registration

(https://www.crd.york.ac.uk/PROSPERO/).

Impact of steatotic liver disease subtypes, sarcopenia, and fibrosis on all-cause and cause-specific mortality: a 15.7-year cohort study

BACKGROUND

Steatotic liver disease (SLD) was a newly proposed disease category derived from metabolic dysfunction-associated fatty liver disease (MAFLD). MAFLD and sarcopenia were independent risk factors for mortality. We aimed to evaluate the impacts of SLD subtypes, MAFLD, and sarcopenia on mortality.

METHODS

A total of 6543 subjects were identified from the National Health and Nutrition Examination Survey 1999-2006 with the latest Linked Mortality file. Hepatic steatosis, advanced fibrosis, and sarcopenia were determined by the laboratory- and anthropometry- based fatty liver index and fibrosis-4 index, and dual-energy X-ray absorptiometry-based appendicular skeletal muscle mass index, respectively. Associations of SLD subtypes, MAFLD, and sarcopenia with mortality were estimated using the weighted Cox proportional hazards model.

RESULTS

During a mean follow-up time of 15.7 years, 1567 (16.7%) deaths occurred including 494 (4.9%) deaths from cardiovascular diseases and 372 (4.1%) from cancer. The all-cause mortality rates of MAFLD, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD), other aetiology SLD, MASLD without sarcopenia, and MASLD with sarcopenia were 21.0%, 19.8%, 30.2%, 30.9%, 19.2%, and 75.5%, respectively. MAFLD increased the risk of all-cause mortality (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.59). MASLD predicted all-cause mortality (HR 1.17, 95% CI 1.03-1.33) but this prediction became insignificant after adjustment for metabolic risks. In contrast, MetALD and other aetiology SLD were significantly associated with all-cause mortality (HR 1.83, 95% CI 1.21-2.76; HR 2.50, 95% CI 1.82-3.44, respectively), predominantly associated with cancer-specific mortality (HR 2.42, 95% CI 1.23-4.74; HR 2.49, 95% CI 1.05-5.90, respectively). MASLD with sarcopenia increased the risk of all-cause mortality by almost twice (HR 2.19, 95% CI 1.37-3.49) and further coexisting advanced fibrosis additively increased mortality (HR 3.41, 95% CI 1.92-6.05).

CONCLUSION

SLD definition identified a more homogeneous group with metabolically hepatic steatosis at higher risks of mortality. MASLD or MASLD-related advanced fibrosis and sarcopenia additively increased mortality.

Effects of night-to-night variations in objectively measured sleep on blood glucose in healthy university students

STUDY OBJECTIVES

We examined associations between daily variations in objectively measured sleep and blood glucose in a sample of non-diabetic young adults to complement laboratory studies on how sleep affects blood glucose levels.

METHODS

One hundred and nineteen university students underwent sleep measurement using an Oura Ring 2 and continuous glucose monitoring (CGM) for up to 14 days. In 69 individuals who consumed a standardized diet across the study, multilevel models examined associations between sleep duration, timing, efficiency, and daily CGM profiles. Separately, in 58 individuals, multilevel models were used to evaluate postprandial glycaemic responses to a test meal challenge on 7 days. Participants also underwent oral glucose tolerance testing once after a night of ad libitum sleep, and again following a night of sleep restriction by 1-2 hours relative to that individual's habitual sleep duration. Between-condition glucose and insulin excursions, HOMA-IR and Matsuda index were compared.

RESULTS

Nocturnal sleep did not significantly influence following-day CGM profiles, postprandial glucose, or nocturnal mean glucose levels (all ps > .05). Longer sleep durations were associated with lower same-night glucose variability (all ps < .001). However, the range of variation in sugar levels was small and unlikely to be of functional significance. Considering naps in the analysis did not alter the findings. Sleep restriction by an average of 1.73 hours (SD = 0.97) did not significantly impact excursions in glucose or insulin or insulin sensitivity the following morning (all ps > .05).

CONCLUSIONS

Glucose handling in young, healthy adults may be more resilient to real-life fluctuations in sleep patterns than previously thought.

CLINICAL TRIAL INFORMATION

Monitoring Sleep and Glucose Among University Students https://clinicaltrials.gov/study/NCT04880629, ID: NCT04880629.

Multifilm Mass Transfer and Reaction Rate Kinetics in a Newly Developed In Vitro Digestion System for Carbohydrate Digestion

Multifilm mass transfer theory has been used in conjunction with developing a new in vitro starch digestion model and applied to assessing starch digestion kinetics. One significance of this research is that this in vitro model has similar dynamics, such as similar Reynolds numbers for both in vivo and in vitro systems. In the in vitro intestine model, when the flow rate changes from 5.9 × 10-6 m3 s-1 to 1.0 × 10-5 m3 s-1 inside the intestine wall (inside the sausage casing), the Re number changes from 362 to 615. An oral digestion model, a stomach model, and an intestine model have been built to quantitatively understand reaction rate kinetics and two-film (or multifilm) mass transfer for carbohydrate digestion. This in vitro digestion system represents the oral mastication process to reduce the length scale of the test food, amylase inhibition in the stomach, and glucose generation and transport through the intestine wall according to the various emptying rates from stomach. Another dimensionless group, the Damköhler number (Da), has been calculated based on glucose measurements from this in vitro model, which show similar glycemic responses of the hydrolysis for banana and carrot with in vivo results. Another significance of this research is to distinguish a low GI food from a high GI one in this in vitro system and the possibility to estimate the GI value based on the glucose measurements.

Prevalence and associated factors of metabolic syndrome among people living with HIV in a medical center of Northern Taiwan

HIV acquisition has been found to be associated with increased risk of cardiometabolic syndrome in the past. In this study, we attempt to delineate the associated factors of metabolic syndrome among persons living with HIV in a single medical center in Taiwan using mostly integrase inhibitors-based regimen as HAART. A cross-sectional study involving all people living with HIV (PLWH) aged ≥ 18 years who visited MacKay Memorial Hospital, Taipei, Taiwan between September 7, 2022 to January 31, 2023 was performed. A modified National Cholesterol Education Program ATP III definition of metabolic syndrome was used to define metabolic syndrome and body mass index was used as surrogate for waist circumference. 809 PLWH participated in the study, in which 81.3% of patients were on integrase inhibitor-based HAART regimen. The prevalence of metabolic syndrome was 10.0%, which is markedly lower than those reported in the literature. Age was a significant risk factor for metabolic syndrome. HIV-related factors (CD4, viral load, HAART regimen) did not affect the presence of metabolic syndrome. Prevalence rate of metabolic syndrome appeared to have declined among PLWH compared to previous reports, possibly secondary to widespread use of integrase inhibitors. Age remains a strong risk factor for the development of metabolic syndrome among PLWH.

Predictive biomarkers for cardiometabolic risk in postmenopausal women: insights into visfatin, adropin, and adiponectin

Background

Visfatin, adropin, and adiponectin are involved in many changes associated with obesity and metabolic disorders, and may be related to metabolic syndrome and cardiovascular disease. The selection of visfatin, adropin, and adiponectin as biomarkers is based on their significant roles in metabolic regulation and inflammation, which are critical factors in cardiometabolic risk. Visfatin is known for its pro-inflammatory properties and its ability to modulate insulin resistance. Adropin is involved in energy homeostasis and metabolic health, while adiponectin has anti-inflammatory and insulin-sensitizing effects. During the perimenopausal period, the risk of obesity, and consequently cardiometabolic diseases increases. Therefore, the aim of this study was to assess the relationship between cardiometabolic parameters and circulating levels of visfatin, adropin, and adiponectin in perimenopausal women with regard to their obesity status.

Materials and methods

This study of 168 perimenopausal women utilized a cross-sectional design with non-random sampling. It involved the use of questionnaires, as well as anthropometric and blood pressure measurements. Blood samples were collected to determine the levels of visfatin, adropin, and adiponectin. Statistical analyses, including correlation coefficients, were performed to evaluate the relationship between these biomarkers and cardiometabolic risk factors, such as insulin resistance, lipid profiles, and inflammatory markers.

Results

In our study, visceral adiposity index and lipid accumulation product negatively correlated with adiponectin levels. Preliminary multivariate linear regression analysis revealed a positive correlation between circulating visfatin and IL-6 levels. Circulating adropin negatively correlated with HbA1C, fasting blood glucose, and insulin. Adiponectin negatively correlated with HbA1C, fasting blood glucose, insulin, and triglycerides. Furthermore, circulating adiponectin positively correlated with HDL, and negatively with HOMA-IR.

Conclusions

Adiponectin is a promising biomarker for predicting cardiometabolic risk in postmenopausal women.

Metabolic dysfunction-associated fatty liver disease indicates more hepatic fibrosis than nonalcoholic fatty liver disease

The term metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed based on a redefinition of the nonalcoholic fatty liver disease (NAFLD) criteria. Our study aimed to address the knowledge gap by comparing the diagnostic accuracy of MAFLD and NAFLD criteria in identifying significant fibrosis among patients with hepatic steatosis. A cross-sectional study was conducted on 2626 patients with hepatic steatosis treated at Beijing Ditan Hospital between January 2009 and December 2022. Patients with viral hepatitis were excluded. Significant fibrosis was defined as a Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) score F ≥ 2. MAFLD and NAFLD were diagnosed in 478 and 428 patients, respectively. Clinicopathological characteristics were compared between the MAFLD+ NAFLD- group (patients who met the criteria for MAFLD but not NAFLD) and MAFLD- NAFLD+ group (patients who met the criteria for NAFLD but not MAFLD). A total of 743 patients with histologically verified hepatic steatosis were analyzed. The MAFLD+ NAFLD- group comprised 163 (21.9%) and the MAFLD- NAFLD+ group comprised 113 (15.2%) patients. Patients in the MAFLD+ NAFLD- group were older and more likely to be male and had higher body mass index and liver stiffness levels than those in the MAFLD- NAFLD+ group. The prevalence of significant fibrosis was higher in the MAFLD+ NAFLD- group than in the MAFLD- NAFLD+ group (43.6% vs 15.9%, P < .001). The MAFLD criteria may be a better indicator of fibrosis than the NAFLD criteria. Fibrosis in patients with MAFLD can be determined by metabolic disorders, not excessive alcohol consumption.

The synergistic effect of the triglyceride-glucose index and a body shape index on cardiovascular mortality: the construction of a novel cardiovascular risk marker

BACKGROUND

Insulin resistance, represented by increased triglyceride-glucose (TyG) index levels, shows interplay with visceral obesity and together promotes cardiovascular diseases and mortality. However, significant controversies exist regarding whether modified TyG indices, such as TyG-BMI, TyG-WC, and TyG-WHtR, outperform the TyG index in predicting cardiovascular outcomes. We aimed to explore whether there was a synergistic effect of a body shape index (ABSI), a better parameter reflecting visceral obesity, and the TyG index on cardiovascular mortality.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2001-2018 of 17,329 individuals. The associations of the TyG index and ABSI with cardiovascular mortality were investigated via Cox regression analysis and restricted cubic splines. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive value. Mediation analysis was used to explore the potential mediator.

RESULTS

A total of 673 (3.9%) cardiovascular deaths occurred during a median follow-up of 8.92 years. Individuals with high TyG and high ABSI (TyG > 9.04 and ABSI > 0.085) were at the highest cardiovascular mortality risk both in individuals with (HR = 1.714, 95% CI 1.123-2.616) and without diabetes (HR = 1.402, 95% CI 1.003-1.960), suggesting a synergistic effect. Next, we multiplied these two indicators and established TyG-ABSI. It showed a J-shaped relationship and a positive linear relationship with cardiovascular mortality in individuals with and without diabetes, respectively. Arterial stiffness, represented by estimated pulse wave velocity, partially mediated the effect of TyG-ABSI on cardiovascular mortality, with a mediation proportion of 42.7%. The predictive value of TyG-ABSI was greater than that of the TyG index, TyG-BMI, TyG-WC, and TyG-WHtR (Harrell's C-index: 0.710 vs 0.623 vs 0.539 vs 0.612 vs 0.622, all p < 0.001).

CONCLUSIONS

The simultaneous assessment of the TyG index and ABSI revealed a synergistic effect on cardiovascular mortality. We recommended the use of TyG-ABSI instead of the TyG index and other modified TyG indices in cardiovascular risk assessment.

Correspondence: insulin resistance and chronic kidney disease in patients without diabetes

Future investigations on the association between insulin resistance in people without diabetes and chronic kidney disease (CKD) should consider the following aspects to facilitate causal inference and provide more robust findings. The study design should have an adequate follow-up period to rule out reverse causation and pre-existing diabetes, as well as to confirm the diagnosis of CKD. Known causes of CKD and relevant covariates should be identified where possible. Homeostasis model assessment of insulin resistance (HOMA-IR), being an indirect measure of insulin resistance, has limited sensitivity and specificity compared to direct methods like the hyperinsulinaemic-euglycaemic clamp. Regression modelling with HOMA-IR quartiles instead of continuous form may have masked more nuanced relationships. Sensitivity analyses, such as spline regression, could provide more insights about the association and mechanism. Propensity score methods could help address the inadequate overlap in covariate distributions, if present, by ensuring covariate balance. When investigating the CKD diagnostic performance of HOMA-IR, its cut-off for clinically meaningful insulin resistance should be well justified or comprehensively explored to improve the reliability of the results.

Asymmetric Dimethylarginine (ADMA) as a Novel Risk Factor for Progression of Coronary Artery Calcification in Patients with Chronic Kidney Disease

Background: Vascular calcification (VC) is a characteristic feature of atherosclerosis in patients with chronic kidney disease (CKD), and coronary artery calcification (CAC) significantly impacts future cardiovascular events and mortality. Although factors associated with CAC are well reported, only a few studies have evaluated the factors associated with the progression of CAC in pre-dialysis patients with CKD. Methods: We quantitatively evaluated CAC progression using the CAC score (CACS) measured using 16-row multi-detector computed tomography and assessed associated factors in 74 patients with CKD. Results: The median annual increase in CACS was 23.7 (IQR 2.0-73.0). CAC progression was associated with serum phosphate and plasma asymmetric dimethylarginine (ADMA) levels, an endogenous inhibitor of nitric-oxide synthase and a marker of endothelial dysfunction and atherosclerosis, in univariate analysis. Multivariate analysis revealed that ADMA is an independent risk factor for CAC progression in patients with CKD. The annual change in CACS was significantly different between patients with ADMA values <0.51 and those with ADMA values >0.51 (p < 0.05). Elevated ADMA levels were also significantly associated with estimated glomerular filtration rate (eGFR) decline in the univariate analysis. Conclusions: ADMA is a novel risk factor for CAC progression in patients with CKD. Vascular endothelial cell dysfunction, represented by elevated ADMA levels, may contribute to the progression of vascular calcification in patients with pre-dialysis CKD.

Age-Related Glucose Intolerance Is Associated with Impaired Insulin Secretion in Community-Dwelling Japanese Adults: The Kumamoto Koshi Study

Background/Objectives: Glucose tolerance progressively declines with age. However, the effects of aging on insulin secretion and insulin sensitivity in Japanese subjects are unclear. Methods: We conducted an oral glucose tolerance test (OGTT) in residents aged between 22 and 85 years in Koshi City, Kumamoto Prefecture, Japan, to clarify the characteristics of insulin secretion and insulin sensitivity in older adults. Participants were recruited using a flyer, and the OGTT was performed after an overnight fast (12-16 h) between 8:00 and 10:30 am. Results: HOMA-IR and the Matsuda index are indices of insulin action. No correlation of age with HOMA-IR or the Matsuda index was found, whereas HOMA-β, the insulinogenic index, and the disposition index, all indices of insulin secretion, were negatively correlated with age in all participants and in individuals with normal glucose tolerance. Multiple regression analysis showed that age was an explanatory factor for insulin secretion. Conclusions: Impaired insulin secretion may contribute to age-related glucose intolerance in Japanese individuals.

Influence of dehydroepiandrosterone sulphate levels on the slower age-related decline in grey matter in younger women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is characterized by excess androgens, ovulatory disorders and a higher prevalence of obesity and metabolic disturbances including Type 2 diabetes, hyperlipidaemia and hypertension, some of which are risk factors for neurodegenerative disorders such as Alzheimer's disease and brain atrophy. However, it is unclear whether brain ageing occurs more rapidly in women with PCOS compared with those without PCOS. Except for the hypothalamic-pituitary-gonadal axis involved in the conventional ovulatory process, little is known regarding the role of the grey matter in the pathogenesis of PCOS, and limited existing studies examining brain structures in PCOS have shown inconsistent results. This case-control study aimed to investigate the age-related differences in total and regional brain grey matter volume and average cortical thickness in young women with and without PCOS by using brain magnetic resonance imaging to understand whether women with PCOS exhibit distinctive patterns of brain ageing, and their association with factors including obesity, hyperandrogenism and metabolic disturbances. Seventy-six women diagnosed with PCOS and 68 age-matched women without PCOS (aged 20-35 years) underwent brain magnetic resonance imaging to measure grey matter volume and cortical thickness. Anthropometric, hormonal and metabolic measurements were conducted to assess their associations with the investigated brain structures. In women without PCOS, increasing age was significantly correlated with a decrease in global grey matter volume (r = -0.5598, P < 0.0001), while this association was not significant in women with PCOS (r = -0.1475, P = 0.204). The decline in grey matter volume with age differed significantly between the two groups regardless of obesity (body mass index exceeding 25 kg/m2), especially in the frontal, parietal, occipital and temporal regions. After adjusting for dehydroepiandrosterone sulphate (DHEAS) levels, the negative association between age and global grey matter volume became statistically significant in women with PCOS. Increasing age was also significantly associated with a decrease in global cortical thickness in women without PCOS, but not in women with PCOS. Such negative association between global cortical thickness and age was particularly stronger in women with obesity compared with those without. The negative association between age and global cortical thickness in women with PCOS became pronounced after adjusting for DHEAS levels. Women with PCOS experience a milder grey matter loss with age compared with women without PCOS. The neuroprotective effect of high DHEAS levels in women with PCOS may be implicated in this relationship.

Gut Bacteria-Derived Tryptamine Ameliorates Diet-Induced Obesity and Insulin Resistance in Mice

Tryptophan is an essential amino acid that is metabolized in the intestine by gut bacteria into indole derivatives, including tryptamine. However, little is known about which bacterial tryptophan metabolites directly influence obesity. In this study, we identified tryptamine as a bacterial metabolite that significantly reduced fat mass following the intraperitoneal injection of five bacterial tryptophan end-products in a diet-induced obese mouse model. Interestingly, tryptamine, a serotonin analog, inhibited both lipogenesis and lipolysis in adipose tissue, which was further confirmed in a 3T3-L1 adipocyte cell culture study. Moreover, oral tryptamine supplementation markedly reduced fat mass and improved insulin sensitivity in a long-term, high-fat-diet, pair-feeding model. These studies demonstrate the therapeutic potential of tryptamine, a bacterial tryptophan metabolite, in ameliorating obesity and insulin resistance by directly regulating lipogenesis and lipolysis in white adipose tissue.