Evaluation of fasting plasma insulin concentration as an estimate of insulin action in nondiabetic individuals: comparison with the homeostasis model assessment of insulin resistance (HOMA-IR)

Evaluating the triglyceride glucose index as a predictive biomarker for osteoporosis in patients with type 2 diabetes

Objective

Osteoporosis is a common condition among individuals with type 2 diabetes; however, the relationship between insulin resistance, as measured by the Triglyceride Glucose Index (TyG), and osteoporosis has not been sufficiently explored. This study seeks to address this research gap by investigating the diagnostic value of TyG in identifying osteoporosis in patients with type 2 diabetes.

Methods

A retrospective analysis was performed on clinical data from 207 diabetic subjects (83 in the osteoporosis group, 124 in the non-osteoporosis group), using SPSS version 27.0 and MedCalc 23 for statistical analysis.

Results

Significant statistical differences were noted between the two groups in terms of gender, age, hemoglobin levels, red blood cell count, total cholesterol levels, and the TyG. Binary logistic regression analysis revealed that gender, age, and TyG are independent predictors of osteoporosis in patients with type 2 diabetes. Receiver operating characteristic (ROC) analysis showed that the area under the curve for TyG, gender, age, and their combination in predicting osteoporosis among patients with T2DM was 0.653, 0.698, 0.760, and 0.857, respectively. Additionally, the diagnostic performance of the TyG value was effectively evaluated, determining 8.78 as the optimal cutoff value, with a corresponding sensitivity of 89.1% and specificity of 52.4%. Meanwhile, the predictive model constructed using gender, age, and the TyG index achieved an area under the curve (AUC) of 0.857 (95% confidence interval: 0.801~0.901), with a maximum Youden index of 0.629. The corresponding diagnostic sensitivity was 83.1% and the specificity was 79.8%.

Conclusion

The TyG holds potential to serve as a prominent biomarker for the diagnosis of osteoporosis among type 2 diabetic patients in various clinical settings.

HOMA-IR and TyG index differ for their relationship with dietary, anthropometric, inflammatory factors and capacity to predict cardiovascular risk

BACKGROUND

HOMA-IR and the triglyceride-glucose index (TyG index) are surrogate indexes of insulin resistance. However, it remains to elucidate how HOMA-IR and the TyG index compare for their relationship with cardiometabolic health.

AIM

This study aimed at comparing HOMA-IR and the TyG index with regard to their relationship with anthropometric, dietary and inflammatory factors as well as ability to predict cardiovascular risk.

METHODS

438 subjects aged 55-80 years, underwent anthropometric, metabolic and nutritional characterisation. Spearman's correlation coefficient was used to evaluate the association between the parameters of interest. Predictors of HOMA-IR, the TyG index and the 10-year risk of cardiovascular events were investigated using stepwise multivariable regression analysis.

RESULTS

HOMA-IR and TyG index correlated positively with body mass index, waist circumference, fat mass, systolic and diastolic blood pressure, interleukin-18 and C-reactive protein. However, only HOMA-IR correlated with dietary factors. After adjusting for age and sex, waist circumference and interleukin-18 were stronger predictors of HOMA-IR compared to the TyG index. Instead, the TyG index, but not HOMA-IR, emerged as a predictor of cardiovascular risk.

CONCLUSIONS

The TyG index represents a better predictor of cardiovascular risk compared to HOMA-IR which, instead, exhibits a stronger relationship with anthropometric, inflammatory and nutritional variables.

Genome-wide association study identifying novel risk variants associated with glycaemic traits in the continental African AWI-Gen cohort

AIMS/HYPOTHESIS

Glycaemic traits such as high fasting glucose levels and insulin resistance are positively associated with the risk of type 2 diabetes and other cardiometabolic diseases. Genetic association studies have identified hundreds of associations for each glycaemic trait, yet very few studies have involved continental African populations. We report the results of genome-wide association studies (GWASs) in a pan-African cohort for four glycaemic traits, namely fasting glucose, fasting insulin, insulin resistance (HOMA-IR) and beta cell function (HOMA-B), which are quantitative variables that affect the risk of developing type 2 diabetes.

METHODS

GWASs for the four traits were conducted in approximately 10,000 individuals from the Africa Wits-INDEPTH Partnership for Genomics Studies (AWI-Gen) cohort, with participants from Burkina Faso, Ghana, Kenya and South Africa. Association testing was performed using linear mixed models implemented in BOLT-LMM, with age, sex, BMI and principal components as covariates. Replication, fine mapping and functional annotation were performed using standard approaches.

RESULTS

We identified a novel signal (rs574173815) in the intron of the ankyrin repeat domain 33B (ANKRD33B) gene associated with fasting glucose, and a novel signal (rs114029796) in the intronic region of the WD repeat domain 7 (WDR7) gene associated with fasting insulin. SNPs in WDR7 have been shown to be associated with type 2 diabetes. A variant (rs74806991) in the intron of ADAM metallopeptidase with thrombospondin type 1 motif 16 (ADAMTS16) and another variant (rs6506934) in the β-1,4-galactosyltransferase 6 gene (B4GALT6) are associated with HOMA-IR. Both ADAMTS16 and B4GALT6 are implicated in the development of type 2 diabetes. In addition, our study replicated several well-established fasting glucose signals in the GCK-YTK6, SLC2A2 and THORLNC gene regions.

CONCLUSIONS/INTERPRETATION

Our findings highlight the importance of performing GWASs for glycaemic traits in under-represented populations, especially continental African populations, to discover novel associated variants and broaden our knowledge of the genetic aetiology of glycaemic traits. The limited replication of well-known signals in this study hints at the possibility of a unique genetic architecture of these traits in African populations.

DATA AVAILABILITY

The dataset used in this study is available in the European Genome-Phenome Archive (EGA) database ( https://ega-archive.org/ ) under study accession code EGAS00001002482. The phenotype dataset accession code is EGAD00001006425 and the genotype dataset accession code is EGAD00010001996. The availability of these datasets is subject to controlled access by the Data and Biospecimen Access Committee of the H3Africa Consortium. GWAS summary statistics are accessible through the NHGRI-EBI GWAS Catalog ( https://www.ebi.ac.uk/gwas/ ).

Triglyceride and Glucose Index as an Optimal Predictor of Metabolic Syndrome in Lebanese Adults

Background: Globally, the prevalence of metabolic syndrome (MetS) is on the rise, especially in Arab countries, which emphasizes the need for reliable ethnic-specific biochemical screening parameters. Methods: Two hundred twenty-one Lebanese adults were enrolled in this cross-sectional study. Biochemical parameters including Homeostasis Model Assessment (HOMA), Triglyceride and Glucose index (TyG), ratio of Triglycerides to High-Density Lipoprotein Cholesterol (TG/HDL-C), Atherogenic Index of Plasma (AIP), and Visceral Adiposity Index (VAI) were assessed for their prediction of MetS. Analysis of covariance, logistic regression, expected-versus-observed case ratio were used to determine model calibration, concordance statistic, area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CIs), sensitivity, specificity, and negative and positive predictive values (PPV, NPV). Results: The prevalence of MetS was 44.3%. All biochemical parameters were significantly associated with MetS, with a strong model discrimination (c-statistic between 0.77 and 0.94). In both sex categories, TyG best predicted MetS (females: cut-off value, 8.34; males: cut-off value, 8.43) and showed good estimation among females, but overestimation among males. HOMA had the lowest discriminatory power in both sex categories. Conclusions: This study suggests that TyG best predicts MetS, while HOMA has the lowest predictive power. Future larger studies need to focus on harmonizing ethnic specific cut-offs and further validating our results.

Patients who received sleeve gastrectomy have lower plasma osteopontin levels than those who did not

BACKGROUND

The aim of this study was to compare metabolic parameters, plasma Osteopontin (OPN) and Hepatocyte Growth Factor (HGF) levels between Sleeve Gastrectomy (SG) patients in their 6th post-operation month and healthy control patients.

METHODS

Height, weight, Body Mass Index (BMI) and laboratory parameters of 58 SG patients aged 18‒65 years (Group 1) and 46 healthy control patients (Group 2) were compared. In addition, preoperative and postoperative sixth-month BMI and laboratory parameters of the patients in Group 1 were compared.

RESULTS

The mean age and gender distributions of the groups were similar (p > 0.05). Mean BMI was 28.9 kg/m2 in Group 1 and 27 kg/m2 in Group 2 (p < 0.01). While plasma HGF levels were similar between both groups, plasma OPN levels were higher in Group 2 (p < 0.001). Fasting plasma glucose, total cholesterol, triglyceride, fasting plasma insulin and insulin resistance values were higher in Group 1, while alanine aminotransferase and aspartate aminotransferase levels were higher in Group 2 (p < 0.05). There was a strong correlation between plasma HGF and OPN levels in Group 1, but not in Group 2 (Rho = 0.805, p < 0.001).

CONCLUSION

OPN and HGF are promising biomarkers that can be used to better understand and detect problems related to obesity. The fact that patients in the early post-SG period had lower plasma OPN and similar plasma HGF compared to non-surgical patients of similar age and gender with higher BMI may be another favorable and previously unknown metabolic effect of SG.

Are HOMA-IR and HOMA-B good predictors for diabetes and pre-diabetes subtypes?

BACKGROUND

To investigate the association between the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Homeostasis Model Assessment of Beta-cell function (HOMA-B) with the incidence of diabetes and pre-diabetes subtypes.

METHODS

A total of 3101 normoglycemic people aged 20-70 years were included in the 6-year follow-up study. Multinomial logistic regression was used to calculate the incidence possibility of isolated Impaired Fasting Glucose (iIFG), isolated Impaired Glucose Tolerance (iIGT), Combined impaired fasting glucose & impaired glucose tolerance (CGI), and Diabetes Mellitus (DM) per standard deviation (SD) increment in HOMA-IR and HOMA-B in the crude and multivariable model.

RESULTS

In the multivariate model, an increase in one SD change in HOMA-IR was associated with a 43, 42, 75, and 92% increased risk of iIFG, iIGT, CGI, and DM, respectively. There was a positive correlation between the increase in HOMA-B and the incidence of iIGT; however, after adjusting the results for metabolic syndrome components, it was inversely correlated with the incidence of iIFG [Odds Ratio = 0.86(0.75-0.99)].

CONCLUSIONS

HOMA-IR is positively correlated with diabetes and pre-diabetes subtypes' incidence, and HOMA-B is inversely correlated with the incidence of iIFG but positively correlated with iIGT incidence. However, none of these alone is a good criterion for predicting diabetes and pre-diabetes.

Improvement of stress adaptation and insulin resistance in women with GDM by WeChat group management during novel coronavirus pneumonia

Aim

To evaluate the improvement of glycemic control and stress adaptation in patients with GDM by mobile phone WeChat management during novel coronavirus pneumonia.

Methods

In this study, 75 women with GDM were included, of whom 35 were included in mobile WeChat group management as the GDM-M group and 40 as the GDM group.

Results

After mobile WeChat group management for 4 weeks, E and NE were lower. MDA was lower, and SOD was higher. HOMA-IR was lower. E, NE, and cortisol were related to HOMA-IR positively, MDA was positively related to HOMA-IR, and SOD was negatively related to HOMA-IR. E and cortisol were positively related to MDA but negatively related to SOD.

Conclusion

The stress adaptation disorder and insulin resistance in patients with GDM who have completed mobile WeChat group management can be improved during novel coronavirus pneumonia. Mobile WeChat management played a positive role in improving the insulin resistance of women with GDM under special circumstances, which may reduce the risk of maternal and fetal complications.

Metabolic Risk Factors in Young Men With Healthy Body Fat But Different Level of Physical Activity

The study was performed to evaluate metabolic risk in young lean individuals characterized by different physical activity. A total of 194 students (93 active with 5–7 h weekly physical activity and 101 inactive) were accepted for the study. The following percentages of body fat were accepted as characteristic for lean men: 14% to 17% in active and 18% to 24% in inactive participants. Circulating glucose, insulin, triacylglycerols (TG), total cholesterol (TC), and high-dendity lipoprotein (HDL)-cholesterol (HDL-C) were assayed. Daily intake of energy and macronutrients was briefly assessed from 24 h food records collected over 4 days preceding blood collection. Insulin and TG differed with respect to physical activity and was lower by 37.5% and 12.5%, respectively, in active versus inactive participants. In active students with upper quartile of body fat percentage, the only significant difference was found between circulating insulin (by 28%, p < .04). In inactive participants with upper quartile of body fat, significant differences were found between levels of insulin and TG (by 25% and by 37.5%, respectively). Diet composition did not differ with respect to the percentage of energy derived from protein, fat, and carbohydrates. An inverse association between insulin level and the percentage of body fat seems to be physiological one because it has been noted in both active and inactive individuals. On the contrary, elevation in circulating TG found exclusively in inactive subjects seems to be secondary to the changes in adiposity and circulating insulin and is followed by tendency to higher levels of TC.

Whey protein preloading can alleviate stress adaptation disorder and improve hyperglycemia in women with gestational diabetes mellitus

AIMS

To investigate the change of stress hormones, oxidative stress and insulin resistance (IR) in women with gestational diabetes mellitus (GDM) after supplement whey protein, in an attempt to gain insights into the prevention and treatment of GDM.

MATERIALS AND METHODS

60 GDM women were recruited in this study, and 30 women received a preload drink containing 20 g whey protein as group GDM-W, and the other 30 women received control flavoring drink as group GDM, and the trial lasted for 14 days. Plasma epinephrine (E), noradrenaline (NE), and cortisol were detected; we also determined levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH). Homeostasis model assessment of insulin resistance (HOMA-IR) was used to assess IR.

RESULTS

In the GDM-W group, postprandial blood glucose was decreased significantly on 3, 5, 7, and 14 days (all p < .05), plasma 2 h insulin was increased by 7.2, 8.6, and 20.5% on days 5, 7, and 14 (p < .05, .05, .01). HOMA-IR was decreased significantly on day 14 (p < .05). MDA was decreased by 20.7% on day 14 (p < .01), and anti-oxidative enzymes' SOD was decreased by 13.4% on day 14 (p < .05) and GSH was decreased by 16.7 and 29.1% on days 7 and 14 (both p < .05). Stress hormones E and cortisol were decreased by 10.8 and 19.8%, respectively, on day 14 (p < .05). There was no significant difference in NE between the two groups within 14 days.

CONCLUSIONS

Whey protein supplementation may improve hyperglycemia by alleviating stress disorder and oxidative stress injury in GDM women. This trial was registered at chictr.org.cn/as ChiCTR1800020413.

Annual decline in β-cell function in patients with type 2 diabetes in China

BACKGROUND

The aim of this study was to investigate the annual decline of β-cell function correlated with disease duration in patients with type 2 diabetes in China.

METHODS

This cross-sectional study included 4792 adults with type 2 diabetes who were recruited from four university hospital diabetes clinics between April 2018 and November 2018. Baseline data were collected from electric medical records. Participants were divided into 21 groups with 1-year diabetes duration interval to assess the decline rate of β-cell function. Homeostatic model assessment model (HOMA 2) model was applied to assess β-cell function. Multiple linear regression model was used to evaluate the association between biochemical and clinical variables and β-cell function.

RESULTS

In Chinese patients with type 2 diabetes, β-cell function declined by 2% annually. Using angiotensin receptor blockade (ARB) (β = .048; P = .011), metformin (β = .138; P = .021), or insulin (β = .142; P = .018) was associated with increased β-cell function. However, increased BMI (β = -.215; P = .022), alcohol consumption (β = -.331; P < .001), haemoglobin A1c (β = -.104; P = .027), or increased diabetes duration (β = -.183; P = .003) was significantly and negatively associated with β-cell function.

CONCLUSIONS

We determined that the annual rate of the β-cell function decline was 2% in patients with type 2 diabetes in China. Moreover, we confirmed a positive relationship between ARB treatment and β-cell function, while BMI and alcohol consumption were significantly and negatively associated with the β-cell function.

Stress adaptation is associated with insulin resistance in women with gestational diabetes mellitus

Aim

Oxidative stress is known to increase the risk of insulin resistance (IR). The aim of this study was to investigate the association between stress hormones and IR in women with gestational diabetes mellitus (GDM), in an attempt to gain insights into the pathogenesis of GDM.

Methods

Recruited in this study were 70 GDM women and 70 healthy pregnant women as control. Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), plasma epinephrine (E), noradrenaline (NE), glucagon, and cortisol levels were detected. IR was assessed by homeostasis model assessment of IR (HOMA-IR) in both groups. Correlations among stress hormones, oxidative stress, and IR were analyzed by Pearson’s correlation after log transformation.

Results

Compared with the Control group, MDA was increased and anti-oxidative enzymes SOD and GSH were decreased significantly in the GDM group. Glucagon, E, and NE in the GDM group were increased by 22.42%, 36.82%, and 35.09%, respectively, as compared with those in the Control group. MDA showed a significant positive correlation, and SOD showed a negative correlation with HOMA-IR in the GDM group. In addition, HOMA-IR was positively related to glucagon, E, NE, and cortisol.

Conclusions

Elevation of stress hormones and stress adaptation disturbance may be associated with the pathogenesis of GDM in pregnant women.

Prolonged plasma glucose elevation on oral glucose tolerance test in young healthy Japanese individuals

AIMS

This study aims to assess insulin secretion and resistance through oral glucose tolerance test (OGTT) among young Japanese individuals.

SUBJECTS AND METHODS

We enrolled 595 young healthy Japanese individuals aged 22-29 years. They underwent an OGTT, and their results were divided into 4 groups (I-IV), according to the time at which their plasma glucose concentration declined below the fasting glucose concentration (30, 60 or 120 minutes or never as groups I, II, III and IV, respectively).

RESULTS

We classified 575 normal glucose-tolerant subjects into 4 groups (I-IV) with I: 28 (4.9%), II: 120 (20.9%), III: 143 (24.9%) and IV: 284 (49.4%) individuals. The Matsuda, insulinogenic and disposition indices were decreased from groups I to IV. ROC curves of disposition index reflecting the composition of insulin secretion and sensitivity classified the prolonged glucose elevation group (group III + IV) from the rapid glucose lowering group (group II; AUC = 0.847).

CONCLUSIONS

Even in a young and healthy Japanese individual within the physiological range of glycaemic control, there is a sequential decrease in insulin sensitivity and secretion.

Relationship between surrogate estimates and direct measurement of insulin resistance in women with polycystic ovary syndrome

PURPOSE

To evaluate the relationship between surrogate estimates of insulin resistance and a direct measurement of insulin-mediated glucose uptake women with and without PCOS.

METHODS

Retrospective cohort study of 75 PCOS and 118 controls. Fasting plasma glucose and insulin concentrations, insulin resistance as determined by the insulin suppression test, calculation of multiple surrogate estimates of insulin resistance, total and free testosterone concentrations, and correlations between the direct measure and surrogate estimates of insulin resistance were evaluated.

RESULT(S)

Surrogate markers of insulin resistance were correlated to a variable, but statistically significant degree with the direct measure of insulin resistance in control population and the women with PCOS. There was no correlation between the surrogate estimates of insulin resistance and total or free plasma testosterone concentrations.

CONCLUSION(S)

The surrogate estimates of insulin resistance evaluated were significantly related to a direct measure of insulin resistance, and this was true of both the control population and women with PCOS. The magnitude of the relationship between the surrogate estimates and the direct measurement was comparable and not significantly altered by androgen levels. Fasting plasma insulin concentration seems to be at least as accurate as any other surrogate estimate, and is by far the simplest.

Effect of Home-Based High-Intensity Interval Training in Patients With Lacunar Stroke: A Randomized Controlled Trial

Background: High-intensity interval training (HIIT) is superior to moderate-intensity continuous training in improving cardiorespiratory fitness in patients with cardiovascular disease, but is it safe, feasible and effective in patients with stroke? We investigated feasibility and effect of early, home-based HIIT in patients with lacunar stroke combined with usual care vs. usual care, only. Methods: Patients with minor stroke (severity: 55/58 point on the Scandinavian Stroke Scale) were randomized to HIIT or usual care in a randomized, controlled trial. We measured the following outcomes at baseline and post-intervention: cardiorespiratory fitness monitored as power output from the Graded Cycling Test with Talk Test (GCT-TT; primary outcome), physical activity, fatigue, depression, well-being, stress, cognition, endothelial function, blood pressure, body mass index, and biomarkers. Results: We included 71 patients (mean age 63.7 ± 9.2), 49 men, 31 in intervention group. Home-based HIIT was feasible with no reported adverse events in relation to the intervention. No significant change between the groups in GCT-TT power output was detected (p = 0.90). The change in time spent on vigorous-intensity activity was 2 h/week and 0.6 h/week, intervention and usual care, respectively (p = 0.045). There were no significant differences between groups in the remaining secondary outcomes. Conclusion: HIIT was feasible and safe in patients with lacunar stroke. Patients can engage early in home-based HIIT when involved in choosing exercise modality and guided by weekly motivational phone calls. Within 3 months, HIIT did, however, not yield effect on cardiorespiratory fitness. We await further evaluation of long-term effects of this intervention on continued regular physical exercise and cardiovascular event. Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT02731235.

Decreased serum neuregulin 4 levels associated with non-alcoholic fatty liver disease in children with obesity

Neuregulin 4 (Nrg4), a newly identified adipokine secreted by brown adipose tissue, is hypothesised to play a crucial role in metabolism. The present study aimed to evaluate the association between serum Nrg4 levels and non-alcoholic fatty liver disease (NAFLD) in children with obesity in China. A total of 123 children with obesity were included in this study. Anthropometric and biochemical parameters were measured in all subjects. NAFLD was diagnosed using ultrasonography. The serum levels of Nrg4, leptin and adiponectin were measured by enzyme-linked immunosorbent assay. NAFLD was identified in 58 children with obesity (47.2%). Serum Nrg4 levels were significantly lower in the NAFLD group (2.24 [1.20, 3.22] ng/mL) than in the control group (5.50 [2.45, 10.85] ng/mL) (p < 0.001). Serum Nrg4 levels were negatively correlated with most of the anthropometric and biochemical parameters (p < 0.05) but were positively correlated with high-density lipoprotein cholesterol (p < 0.05). In multiple stepwise regression analyses, serum Nrg4 levels were independently related with WHtR (β = -2.009, p = 0.048) and homeostasis model assessment of insulin resistance (β = -0.524, p = 0.005). Furthermore, a multivariable logistic regression analysis of NAFLD prediction by Nrg4 revealed an odds ratio of 0.129 (95% confidence interval: 0.028-0.587, p < 0.01). The receiver operating characteristic curve analysis of the diagnostic value of using serum Nrg4 levels to differentiate NAFLD in children with obesity showed that the area under the curve was 0.723; the cutoff for serum Nrg4 levels to have diagnostic value for predicting NAFLD in children with obesity was 3.39 ng/mL. Elevated Nrg4 is associated with a decreased risk of NAFLD in children with obesity.

The Principles of Biomedical Scientific Writing: Introduction

A well-written introduction of a scientific paper provides relevant background knowledge to convince the readers about the rationale, importance, and novelty of the research. The introduction should inform the readers about the "problem", "existing solutions", and "main limitations or gaps of knowledge". The authors' hypothesis and methodological approach used to examine the research hypothesis should also be stated. After reading a good introduction, readers should be guided through "a general context" to "a specific area" and "a research question". Incomplete, inaccurate, or outdated reviews of the literature are the more common pitfalls of an introduction that may lead to rejection. This review focuses on the principles of writing the introduction of an article and provides a quick look at the essential points that should be considered for writing an optimal introduction.

Circulating Sphingolipids, Insulin, HOMA-IR, and HOMA-B: The Strong Heart Family Study

Experimental studies suggest ceramides may play a role in insulin resistance. However, the relationships of circulating ceramides and related sphingolipids with plasma insulin have been underexplored in humans. We measured 15 ceramide and sphingomyelin species in fasting baseline samples from the Strong Heart Family Study (SHFS), a prospective cohort of American Indians. We examined sphingolipid associations with both baseline and follow-up measures of plasma insulin, HOMA of insulin resistance (HOMA-IR), and HOMA of β-cell function (HOMA-B) after adjustment for risk factors. Among the 2,086 participants without diabetes, higher levels of plasma ceramides carrying the fatty acids 16:0 (16 carbons, 0 double bond), 18:0, 20:0, or 22:0 were associated with higher plasma insulin and higher HOMA-IR at baseline and at follow-up an average of 5.4 years later. For example, a twofold higher baseline concentration of ceramide 16:0 was associated with 14% higher baseline insulin (P < 0.0001). Associations between sphingomyelin species carrying 18:0, 20:0, 22:0, or 24:0 and insulin were modified by BMI (P < 0.003): higher levels were associated with lower fasting insulin, HOMA-IR, and HOMA-B among those with normal BMI. Our study suggests lowering circulating ceramides might be a target in prediabetes and targeting circulating sphingomyelins should take into account BMI.

Identification, characterization, and expression analysis of adiponectin receptors in black carp Mylopharyngodon piceus in response to dietary carbohydrate

In the present study, three cDNAs of AdipoRs (MpAdipoR1a, MpAdipoR1b, and MpAdipoR2) were identified from juvenile black carp Mylopharyngodon piceus. There were 375, 378, and 356 amino acids in the MpAdipoR1a, MpAdipoR1b, and MpAdipoR2, respectively. BLAST analysis reveals that MpAdipoRs share high identities with other known AdipoRs from zebrafish, rainbow trout, human, etc. And there were all seven transmembrane regions in the amino acid sequences of MpAdipoR1s and MpAdipoR2, respectively. The relative expression levels of MpAdipoR1s were higher in the liver, blood, brain, and eyes in black carp (p < 0.05). Relatively higher expression of MpAdipoR2 was detected in the liver (p < 0.05) and then in the adipose tissues and blood by real-time PCR assays. The relative expression levels of AdipoR mRNA in the liver, muscle, brain, blood, and adipose tissues were detected by real-time PCR in black carp fed with four levels of dietary carbohydrate (CHO) (10.65, 19.43, 28.84, and 37.91%) for 9 weeks, respectively. The expression levels of MpAdipoR1s in the liver, muscle, brain, and blood were induced and reached to the maximum at optimal dietary CHO (19.43 or 28.84%) and then were decreased at 37.91% dietary CHO, although there were no significant differences on the expression levels of MpAdipoR1a in the liver between 19.43, 28.84, and 37.91% dietary CHO. Similarly, MpAdipoR2 were also induced to the maximal levels in the liver, muscle, brain, and blood at optimal dietary CHO (19.43 or 28.84%) compared with that at 10.65% dietary CHO, although no significant differences were observed on the expression levels of MpAdipoR2 in the liver and muscle between groups fed 19.43 and 37.91% dietary CHO (p > 0.05). However, the expression levels of MpAdipoRs in the adipose tissues were significantly downregulated at excessive dietary CHO (37.91%) compared with other groups (p < 0.05). These results indicated that MpAdipoRs were inducible proteins and might enhance the understanding of their vital roles in the regulation of glucose metabolic homeostasis in black carp.

Christian Orthodox fasting in practice: A comparative evaluation between Greek Orthodox general population fasters and Athonian monks

OBJECTIVES

Christian Orthodox fasting (COF), a periodical vegetarian subset of the Mediterranean diet, has been proven to exert beneficial effects on human health. Athonian fasting is a pescetarian COF variation, where red meat is strictly restricted throughout the year. Previous studies have examined the COF nutritional synthesis and health effects in general population fasters (GF) and Athonian monks (AM), separately. The aim of this study is to comparatively evaluate the characteristics and effects of this nutritional advocacy between the two populations.

METHODS

The study included 43 male GFs (20-45 y of age) and 57 age-matched male AMs following COF. Dietary intake data were collected in both groups during a restrictive (RD) and a nonrestrictive (NRD) day. Nutritional, cardiometabolic, and anthropometric parameters were compared between the two cohorts.

RESULTS

AM presented lower daily total caloric intake for both RD (1362.42 ± 84.52 versus 1575.47 ± 285.96 kcal, P < 0.001) and NRD (1571.55 ± 81.07 versus 2137.80 ± 470.84 kcal, P < 0.001) than GF.They also demonstrated lower body mass index (23.77 ± 3.91 versus 28.92 ± 4.50 kg/m², P <0.001), body fat mass (14.57 ± 8.98 versus 24.61 ± 11.18 kg, P = 0.001), and homeostatic model assessment for insulin resistance values (0.98 ± 0.72 versus 2.67 ± 2.19 mmol/L, P < .001) than GF. Secondary hyperparathyroidism (parathyroid hormone concentrations: 116.08 ± 49.74 pg/mL), as a result of profound hypovitaminosis D [25(OH)D: 9.27 ± 5.81 ng/mL], was evident in the AM group.

CONCLUSIONS

The results of the present study highlight the unique characteristics of Athonian fasting and its value as a health-promoting diet. The effects of limitation of specific vitamins and minerals during fasting warrants further investigation.

Prolactin regulatory element-binding (PREB) protein regulates hepatic glucose homeostasis

Prolactin regulatory element-binding (PREB) protein is a transcription factor that regulates prolactin (PRL) gene expression. PRL, also known as luteotropic hormone or luteotropin, is well known for its role in producing milk. However, the role of PREB, in terms of hepatic glucose metabolism, is not well elucidated. Here, we observed expression of Preb in the mouse liver, in connection with glucose homeostasis. Morevoer, Preb was downregulated in db/db, ob/ob and high-fat diet-induced obese (DIO) mice, concurrent with upregulation of the liver genes glucose-6-phosphatase (G6pc) and phosphoenolpyruvate carboxykinase-1 (Pck). Administration of adenovirus-Preb (Ad-Preb) to db/db, ob/ob, and DIO mice diminished glucose, insulin, and pyruvate tolerance, which analogously, were impaired in normal (C57BL/6) mice knocked down for Preb, via infection with Ad-shPreb (anti-Preb RNA), indicating Preb to be a negative regulator of liver gluconeogenic genes. We further demonstrate that Preb negatively influences gluconeogenic gene expression, by directly binding to their promoters at a prolactin core-binding element (PCBE). A better understanding of Preb gene expression, during the pathogenesis of hepatic insulin resistance, could ultimately provide new avenues for therapies for metabolic syndrome, obesity, and type-2 diabetes mellitus, disorders whose worldwide incidences are increasing drastically.

Factors associated with elevated blood pressure or hypertension in Afro-Caribbean youth: a cross-sectional study

Background

Although several studies have identified risk factors for high blood pressure (BP), data from Afro-Caribbean populations are limited. Additionally, less is known about how putative risk factors operate in young adults and how social factors influence the risk of high BP. In this study, we estimated the relative risk for elevated BP or hypertension (EBP/HTN), defined as BP ≥ 120/80 mmHg, among young adults with putative cardiovascular disease (CVD) risk factors in Jamaica and evaluated whether relative risks differed by sex.

Methods

Data from 898 young adults, 18–20 years old, were analysed. BP was measured with a mercury sphygmomanometer after participants had been seated for 5 min. Anthropometric measurements were obtained, and glucose, lipids and insulin measured from a fasting venous blood sample. Data on socioeconomic status (SES) were obtained via questionnaire. CVD risk factor status was defined using standard cut-points or the upper quintile of the distribution where the numbers meeting standard cut-points were small. Relative risks were estimated using odds ratios (OR) from logistic regression models.

Results

Prevalence of EBP/HTN was 30% among males and 13% among females (p < 0.001 for sex difference). There was evidence for sex interaction in the relationship between EBP/HTN and some of risk factors (obesity and household possessions), therefore we report sex-specific analyses. In multivariable logistic regression models, factors independently associated with EBP/HTN among men were obesity (OR 8.48, 95% CI [2.64–27.2], p < 0.001), and high glucose (OR 2.01, CI [1.20–3.37], p = 0.008), while high HOMA-IR did not achieve statistical significance (OR 2.08, CI [0.94–4.58], p = 0.069). In similar models for women, high triglycerides (OR 1.98, CI [1.03–3.81], p = 0.040) and high HOMA-IR (OR 2.07, CI [1.03–4.12], p = 0.039) were positively associated with EBP/HTN. Lower SES was also associated with higher odds for EBP/HTN (OR 4.63, CI [1.31–16.4], p = 0.017, for moderate vs. high household possessions; OR 2.61, CI [0.70–9.77], p = 0.154 for low vs. high household possessions). Alcohol consumption was associated with lower odds of EBP/HTN among females only; OR 0.41 (CI [0.18–0.90], p = 0.026) for drinking <1 time per week vs. never drinkers, and OR 0.28 (CI [0.11–0.76], p = 0.012) for drinking ≥3 times per week vs. never drinkers. Physical activity was inversely associated with EBP/HTN in both males and females.

Conclusion

Factors associated with EBP/HTN among Jamaican young adults include obesity, high glucose, high triglycerides and high HOMA-IR, with some significant differences by sex. Among women lower SES was positively associated with EBP/HTN, while moderate alcohol consumption was associated lower odds of EBP/HTN.

Nocturnal but not Diurnal Hypertension Is Associated to Insulin Resistance Markers in Subjects With Normal or Mildly Elevated Office Blood Pressure

OBJECTIVE

The aim was to evaluate the relationships among insulin resistance markers and nocturnal and diurnal hypertension in normotensive or mildly untreated hypertensive adults.

METHODS

The study was performed in both female and male adults referred to the Cardiometabolic Unit of the Hospital San Martín, La Plata, Argentina, in order to perform an ambulatory blood pressure measurement (ABPM) for the evaluation of a possible hypertensive disorder. The population was stratified according to their ABPM in: 1-presence or absence of diurnal hypertension and 2-presence or absence of nocturnal hypertension; both conditions were analyzed separately. Fasting plasma insulin (FPI), homeostasis model assessment of insulin resistance (HOMA-IR), and triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) ratio were used as surrogate markers of insulin resistance and compared among subjects with vs. without diurnal or nocturnal hypertension.

RESULTS

One hundred and five patients, 55 women, 47 (11) years old, and 50 men, 44 (16) years old, were included. Diurnal and nocturnal hypertension were found in 60% and 64% of the sample, respectively. There were no significant differences among the levels of insulin resistance markers between individuals with or without diurnal hypertension. In contrast, individuals with nocturnal hypertension were more insulin resistant irrespectively of whether they were evaluated using FPI (P = 0.016), HOMA-IR (P = 0.019), or TG/HDL-C ratio (P = 0.011); FPI differences remained significant after adjustment for sex, age, and obesity indicators (P = 0.032).

CONCLUSIONS

Nocturnal but not diurnal hypertension was related to higher levels of 3 insulin resistance markers in normotensive and untreated mildly hypertensive adults; this relationship seems partially independent of obesity.

Salivary extracellular RNA biomarkers for insulin resistance detection in hispanics

AIMS

Insulin resistance (IR) detection is challenging and no test is currently used in clinical practice. We developed salivary biomarkers that could be used for IR detection.

METHODS

We collected saliva from 186 healthy and 276 pre-diabetic participants, divided them into high and low IR groups based on a HOMA cutoff of 2.5. We profiled extracellular transcriptome by microarray in saliva supernatant from 23 high IR and 15 low IR participants, and pre-validated the top ten extracellular mRNA (exRNA) markers in a new cohort of 40 high and 40 low IR participants. A prediction panel was then built and validated in an independent cohort of 149 high and 195 low IR participants.

RESULTS

Transcriptomic analyses identified 42 exRNA candidates differentially present in saliva of high and low IR participants. From the top ten candidates, six were individually validated (PRKCB, S100A12, IL1R2, CAMP, VPS4B, CAP1) (p<0.01) and yielded AUC values ranging from 0.66 to 0.76. Body mass index (BMI) was significant higher in high compared to low IR group with AUC of 0.66, and showed no correlation with any of candidate biomarkers. The combination of four exRNA markers (IL1R2, VPS4B, CAP1, LUZP6) with BMI achieved excellent results in the prediction panel building dataset (AUC=0.79, sensitivity=79%, specificity=64%). The prediction model was validated in an independent cohort (AUC=0.82, sensitivity=63%, specificity=92%).

CONCLUSIONS

A panel of four salivary exRNA biomarkers (IL1R2, VPS4B, CAP1, LUZP6) and BMI was validated that can distinguish high and low IR participants, overall and in subgroups of healthy and pre-diabetic participants.

Lipid and inflammatory biomarker profiles in early insulin resistance

AIMS

To analyze the serum lipid and inflammatory biomarker profile in the early insulin resistance (e-IR).

METHODS

Cross-sectional study of 5943 adults without diabetes, stratified into no IR group (C-peptide <third tertile and glucose <100 mg/dL), e-IR group (C-peptide ≥third tertile and glucose <100 mg/dL) and advanced IR group (glucose ≥100 mg/dL).

RESULTS

E-IR showed significant differences with no IR in the serum concentration of triglycerides (P < 0.001), HDL cholesterol (P < 0.001), LDL cholesterol (P < 0.001), sCD40L (P < 0.001), C-reactive protein (P < 0.004), leptin (P < 0.001) and adiponectin (P < 0.001). Adjusting for age, gender and abdominal obesity, corroborated the association of e-IR with highest quintile of triglycerides (OR 3.88 [3.07-4.89]), HDL cholesterol (OR 0.35 [0.28-0.44]), sCD40L (OR 0.47 [0.24-0.94]), C-reactive protein (OR 2.31 [1.29-4.12]), adiponectin (OR 0.11 [0.04-0.32]), PAI-1 (OR 3.29 [1.29-8.40]) and resistin (OR 1.25 [1.01-1.54]); the same biomarkers were associated with advanced IR although resistin was a protective factor (OR 0.73 [0.58-0.93]).

CONCLUSIONS

Euglycemic patients with e-IR present an unfavorable serum lipid and inflammatory biomarker profile. Measuring C-peptide in euglycemic patients with elevated triglycerides identifies e-IR.

Metabolic Markers to Predict Incident Diabetes Mellitus in Statin-Treated Patients (from the Treating to New Targets and the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trials)

The goal of this analysis was to evaluate the ability of insulin resistance, identified by the presence of prediabetes mellitus (PreDM) combined with either an elevated triglyceride (TG >1.7 mmol/l) or body mass index (BMI ≥27.0 kg/m²), to identify increased risk of statin-associated type 2 diabetes mellitus (T2DM). Consequently, a retrospective analysis of data from subjects without diabetes in the Treating to New Targets and the Stroke Prevention by Aggressive Reduction in Cholesterol Levels randomized controlled trials was performed, subdividing participants into 4 experimental groups: (1) normal fasting glucose (NFG) and TG ≤1.7 mmol/l (42%); (2) NFG and TG >1.7 mmol/l (22%); (3) PreDM and TG ≤1.7 mmol/l (20%); and (4) PreDM and TG >1.7 mmol/l (15%). Comparable groupings were created substituting BMI values (kg/m² <27.0 and ≥27.0) for TG concentrations. Patients received atorvastatin or placebo for a median duration of 4.9 years. Incident T2DM, defined by developing at least 2 fasting plasma glucose (FPG) concentrations ≥126 mg/dl, an increase in FPG ≥37 mg/dl, or a clinical diagnosis of T2DM, was observed in 8.2% of the total population. T2DM event rates (statin or placebo) varied from a low of 2.8%/3.2% (NFG and TG ≤1.7 mmol/l) to a high of 22.8%/7.6% (PreDM and TG >1.7 mmol/l) with intermediate values for only an elevated TG >1.7 mmol/l (5.2%/4.3%) or only PreDM (12.8%/7.6%). Comparable differences were observed when BMI values were substituted for TG concentrations. In conclusion, these data suggest that (1) the diabetogenic impact of statin treatment is relatively modest in general; (2) the diabetogenic impact is accentuated relatively dramatically as FPG and TG concentrations and BMI increase; and (3) PreDM, TG concentrations, and BMI identify people at highest risk of statin-associated T2DM.

Insulin resistance: The linchpin between prediabetes and cardiovascular disease

The aim of this study was to test the hypothesis that cardiovascular disease occurs to the greatest extent in persons with prediabetes mellitus who are also insulin resistant. In 2003, 664 non-diabetic women (n = 457) and men (n = 207), aged 52 ± 16 and 53 ± 15 years, were surveyed during a programme for cardiovascular disease prevention. Fasting plasma glucose concentrations defined participants as having normal fasting plasma glucose (fasting plasma glucose <5.6 mmol/L) or prediabetes mellitus (fasting plasma glucose ⩾ 5.6 and <7.0 mmol/L). The tertile of prediabetes mellitus subjects with the highest fasting plasma insulin concentration was classified as insulin resistant. Baseline cardiovascular disease risk factors were accentuated in prediabetes mellitus versus normal fasting glucose, particularly in prediabetes mellitus/insulin resistant. In 2012, 86% of the sample were surveyed again, and the crude incidence for cardiovascular disease was higher in subjects with prediabetes mellitus versus normal fasting glucose (13.7 vs 6.0/100 persons/10 years; age- and sex-adjusted hazard ratio = 1.88, p = 0.052). In prediabetes mellitus, the crude incidences were 22.9 versus 9.6/100 persons/10 years in insulin resistant versus non-insulin resistant persons (age- and sex-adjusted hazard ratio = 2.36, p = 0.040). In conclusion, cardiovascular disease risk was accentuated in prediabetes mellitus/insulin resistant individuals, with a relative risk approximately twice as high compared to prediabetes mellitus/non-insulin resistant subjects.

Cut-off points of homeostasis model assessment of insulin resistance, beta-cell function, and fasting serum insulin to identify future type 2 diabetes: Tehran Lipid and Glucose Study

AIMS

To determine cut-off points of homeostasis model assessment of insulin resistance (HOMA-IR), β-cell function (HOMA-B), insulin sensitivity (HOMA-S), and fasting insulin for identifying the subjects with type 2 diabetes mellitus (T2DM) in Iranian adults using data from a prospective population-based study.

METHODS

From participants of Tehran Lipid and Glucose Study, 4942 Iranian subjects, aged 20-86 years, were followed for incident T2DM. Fasting serum insulin was determined by the electrochemiluminescence immunoasaay. The associations between HOMA-IR, HOMA-B, HOMA-S, and fasting insulin and incident T2DM were evaluated using Cox proportional hazards models. The receiver operator characteristic curve analysis was used to determine the cut-off points of HOMA-IR, HOMA-B, HOMA-S, and fasting insulin.

RESULTS

After 9.2 year follow-up, 346 (7.0 %) incident cases of T2DM were identified; the risk-factor-adjusted hazard ratios for HOMA1-IR, HOMA2-IR, HOMA1-B, HOMA2-B, HOMA1-S, HOMA2-S, and insulin were 1.15, 1.70, 0.732, 0.997, 0.974, 0.986, and 1.01 in women and 1.37, 1.67, 0.588, 0.993, 0.986, 0.991, and 1.06 in men, respectively (all p < 0.05 except for HOMA2-B in women). Optimal cut-off points for HOMA1-IR, HOMA2-IR, HOMA1-B, HOMA2-B, HOMA1-S, HOMA2-S, and insulin were 1.85, 1.41, 86.2, 72.5, 54.1, 63.7, and 11.13 µU/ml in women and 2.17, 1.18, 67.1, 74.6, 46.1, 74.1, and 9.16 µU/ml in men, respectively.

CONCLUSIONS

HOMA-IR, HOMA-B (except for HOMA2-B in women), HOMA-S, and fasting insulin were independent predictors of T2DM. Optimal cut-off points of HOMA-IR, HOMA-B, HOMA-S, and fasting serum insulin were determined from a population-based study for identifying incident T2DM.

Plasma triglyceride determination can identify increased risk of statin-induced type 2 diabetes: a hypothesis

OBJECTIVE

To evaluate the ability of plasma triglyceride (TG) measurements to identify statin-treated persons at accentuated risk of statin-induced type 2 diabetes (T2DM).

METHODS

The experimental population consisted of nondiabetic, statin-treated patients (n = 469), classified as being at high risk for T2DM, subdivided on the basis of a plasma TG concentration of 1.7 mmol/L. Comparisons were made of demographic characteristics, concentrations of fasting glucose, insulin, HbA1c, and hs-CRP, oral glucose tolerance tests, estimates of insulin action and secretion, and lipid/lipoprotein profiles.

RESULTS

Despite similar fasting glucose and HbA1c concentrations, patients with elevated TG concentrations displayed markers of increased risk of T2DM (insulin resistance and compensatory hyperinsulinemia), more adverse lipid/lipoprotein profiles, and increased prevalence of abnormal hs-CRP values.

CONCLUSION

These findings demonstrate that plasma TG concentrations ≥ 1.7 mmol/L identified a subset of individuals at enhanced risk of developing statin-induced diabetes within a population classified prior to statin treatment as being at high risk of T2DM.

Blood inorganic mercury is directly associated with glucose levels in the human population and may be linked to processed food intake

BACKGROUND

The goals of the study were (1) to determine the impact of inorganic mercury exposure on glucose homeostasis; and (2) to evaluate the effectiveness of two community-based interventions in promoting dietary changes among American Indian college students to reduce risk factors for Type-2 Diabetes including fasting glucose, insulin, and mercury levels, weight, and body mass index.

METHODS

To accomplish goal one, the National Health and Nutrition Examination Survey (NHANES) dataset was analyzed using a previously published method to determine if there is a relationship between inorganic blood mercury and fasting glucose. To accomplish goal two, ten college students were recruited and randomly assigned to a group receiving the online macroepigenetics nutrition course and the support group for eliminating corn sweeteners. Participants in both groups were assessed for diet patterns, weight, body mass index (BMI), fasting glucose, insulin, and mercury levels. The interventions were implemented over a 10-week period.

RESULTS

Analysis of the NHANES data (n=16,232) determined a direct relationship between inorganic mercury in blood and fasting glucose levels (p<0.001). The participants who took the online macroepigenetics nutrition intervention course significantly improved their diets (p<0.01), and fasting blood glucose levels (p<0.01) while having lower levels of inorganic mercury in their blood compared to the subjects in the group who eliminated corn sweeteners from their diet and participated in the support group. The trend in lower blood inorganic mercury was strong with p=0.052. The participants in the support group who eliminated corn sweeteners from their diet achieved significant weight loss (p<0.01) and reduced their body mass index (p<0.01).

CONCLUSION

Total blood mercury levels may be influenced by dietary intake of highly processed foods and lower inorganic mercury levels are associated with lower fasting glucose levels. Alternative community-based interventions emphasizing the role food ingredients and toxic substances play in gene modulation and the development of diseases can result in significant dietary improvements and reductions in risk factors associated with type-2 diabetes. A healthier diet can be promoted among community members using a novel online nutrition course. Consumption of corn sweeteners may be a risk factor in the development of obesity.

Modulation of coronary heart disease risk by insulin resistance in subjects with normal glucose tolerance or prediabetes

AIMS

This study was based on the hypothesis that: (1) coronary heart disease (CHD) risk is accentuated in the insulin-resistant subset of persons with normal glucose tolerance (NGT) or prediabetes (PreDM); (2) the prevalence of insulin resistance, and associated abnormalities, is greater in subjects with PreDM; and (3) insulin resistance is the major contributor to increased CHD risk in these individuals.

METHODS

A 75 g oral glucose challenge was used to classify volunteers as having NGT or PreDM. Steady-state plasma glucose (SSPG) concentrations during the insulin suppression test subdivided both groups into insulin sensitive (IS = SSPG < 8.4 mmol/L) or resistant (IR = SSPG ≥ 8.4 mmol/L). Measurements were made of demographic characteristics, blood pressure, and lipid and lipoprotein concentrations, and comparisons made between the subgroups.

RESULTS

Subjects with PreDM (n = 127) were somewhat older, more likely to be non-Hispanic men, with increased adiposity than those with NGT (n = 315). In addition, they had higher FPG concentrations, were insulin resistant (SSPG concentration; 11.4 vs. 7.2 mmol/L), with higher blood pressures, and a significantly more adverse CHD risk lipid profile (p < 0.001). Twice as many subjects with PreDM were IR (72 vs. 35 %), and the CHD risk profile was significantly worse in the IR subgroups in those with either NGT or PreDM.

CONCLUSIONS

Coronary heart disease risk profile is significantly more adverse in subjects with PreDM as compared to individuals with NGT. However, glucose tolerance status is not the only determinant of CHD risk in nondiabetic individuals, and differences in degree of insulin resistance significantly modulate CHD risk in subjects with NGT or PreDM.

HDL2-cholesterol/HDL3-cholesterol ratio was associated with insulin resistance, high-molecular-weight adiponectin, and components for metabolic syndrome in Japanese

AIMS

Recent data have suggested a relationship between the high-density lipoprotein (HDL) subclass ratio and metabolic syndrome (MetS). However, limited information is available regarding the relationships between the HDL subclass ratio and insulin resistance, associated adipocytokine levels, and MetS components. The associations of the high-density lipoprotein 2 cholesterol (HDL2-C) to high-density lipoprotein 3 cholesterol (HDL3-C) ratio with the homeostasis model assessment of insulin resistance (HOMA-IR) index, high-molecular-weight adiponectin (HMW-Ad) levels, and MetS components were examined.

METHODS

The study included 1155 Japanese subjects who met our inclusion criteria and underwent an annual health examination that included an HDL subclass analysis.

RESULTS

The HDL2-C/HDL3-C ratio and the HMW-Ad level gradually decreased as the number of MetS components increased. In contrast, HOMA-IR gradually increased as the number of MetS components increased. The HDL2-C/HDL3-C ratio correlated inversely with HOMA-IR and positively with the HMW-Ad level. A strong positive correlation was observed between the HDL2-C/HDL3-C ratio and the HDL-C level. The HDL2-C/HDL3-C ratio exhibited moderate negative correlations with the body mass index, waist circumference, and triglyceride level. Weak negative correlations were observed for the HDL2-C/HDL3-C ratio with the systolic and diastolic blood pressure and fasting plasma glucose levels.

CONCLUSIONS

Our data indicated that the HDL2-C/HDL3-C ratio was associated with insulin resistance, the HMW-Ad level, and MetS components, and it was useful for evaluating MetS in Japanese individuals.

Different distribution of phenotypes and glucose tolerance categories associated with two alternative proposed cutoffs of insulin resistance

We investigated whether two alternative HOMA-IR thresholds recently proposed identify similar phenotype and have the same impact on gluco-metabolic risk. The two IR cutoffs, IR1 and IR2 (IR1: HOMA-IR >5.9 and IR2: HOMA-IR between 2.8 and 5.9 with HDL-C <51 mg/dl), were applied to a database of 2,360 outpatients, and their association with phenotypes, glucose tolerance, lipids and metabolic syndrome (MetS) was examined. IR1 group showed 5.5% of overweight versus 27.8% of IR2 subjects, and obesity was present in 92.3 versus 68.4%, respectively. We observed the major prevalence of pathological waist in IR1 compared to IR2 subjects: 96.0 versus 80.5% (p < 0.001). After OGTT, IR1 patients presented higher prevalence of impaired glucose tolerance (IGT: 25.8 vs. 20.2%, p < 0.001) and DM2 was diagnosed in 39.7% of IR1 versus 11.3% of IR2 patients (p < 0.001) with odds ratio (OR) 8.3 (95% CI 6.1-11.6) versus 0.8 (0.6-1.2), respectively. IR1 versus IR2 cutpoint showed higher significant (mean ± SEM) total cholesterol (224.8 ± 2.6 vs. 213.1 ± 1.7 mg/dl, p < 0.001) and triglyceride (208.1 ± 12.3 vs. 177.4 ± 4.8 mg/dl, p < 0.001) levels. MetS prevalence was significantly higher in IR1 than IR2 (89.0 vs. 78.3%, p < 0.001). The IR1 cutpoint was associated with a higher OR of MetS 7.3 (5.3-10.2) versus 5.2 (2.8-9.5) of IR2. In summary, the two alternative HOMA-IR cutoffs identify subjects with different distribution of phenotypes and gluco-metabolic risk. The IR1 patients are characterized by higher prevalence of obesity, pathological waist, MetS, dyslipidemia and IGT/DM2.