Are hypertriglyceridemia and low HDL causal factors in the development of insulin resistance?

Waist circumference mediates the relationship between atherogenic index of plasma and infertility

Background

A newly developed technique, Atherogenic Index of Plasma (AIP), is linked to numerous metabolic disorders. Prior researches have indicated strong correlation between AIP and waist circumference (WC), as well as between WC and infertility. Yet no investigation has examined link involving the AIP and infertility, as well as the potential mediating role of WC in this relationship.

Methods

The study included 1,322 women from the 2013-2018 NHANES. Infertility was the outcome variable. Moreover, mediation analysis explored the mediating role of WC in the above relationships.

Results

There were 1,163 controls and 159 infertile participants among the 1,322 participants. The study demonstrated increased WC and elevated AIP among infertile women. Also, the AIP demonstrated an independent correlation with a higher likelihood of infertility, regardless of adjustments for confounding factors. Subgroup analysis indicated the AIP was related to the prevalence of infertility even among women aged 35 years or younger with no history of cardiovascular disease (CVD), pelvic infections, or use of female hormones. Finally, WC had a substantial mediating effect on correlation between AIP and infertility, accounting for 54.49% of the association. Yet, it appears that the various IR surrogates did not demonstrate variability in their predictive ability for infertility [AIP: 0.642 (95% CI: 0.599, 0.683) vs. WC 0.658 (95% CI: 0.618, 0.705) vs. HOMA-IR 0.637 (95% CI: 0.593, 0.686)].

Conclusion

A notable positive correlation exists between AIP and female infertility. It provides the first evidence to demonstrate the mediating role of WC in the above relationship. Managing abdominal obesity and monitoring AIP levels may contribute to reduce the likelihood of infertility.

Atherogenic index of plasma, high sensitivity C-reactive protein and incident diabetes among middle-aged and elderly adults in China: a national cohort study

BACKGROUND

The atherogenic index of plasma (AIP) and systematic inflammation, as measured by high-sensitivity C-reactive protein (hsCRP), are predictors of diabetes, but their combined impacts on incident diabetes are poorly understood. Using a nationally representative cohort in China, we aimed to investigate the association of AIP and hsCRP with incident diabetes among middle-aged and elderly adults.

METHODS

This cohort comprised 9,112 participants aged at least 45 years from 125 cities in the China Health and Retirement Longitudinal Study who were free of diabetes at baseline in 2011. Of these, 5,048 participants were followed up until 2015. The AIP was calculated as Log10[TG (mg/dL)/HDL-C(mg/dL)]. Multivariate logistic regression and linear mixed-effect (LME) models were performed to evaluate the associations of AIP, hsCRP, and incident diabetes as well as glycemic biomarkers. Receiver operating characteristic (ROC) curves were used to evaluate their diagnostic values. We conducted a mediation analysis to assess the direct and indirect associations between AIP and hsCRP with diabetes.

RESULTS

489 (9.7%) cases developed diabetes during four years. Higher levels of AIP and hsCRP were independently associated with diabetes. Compared to the lowest quartile of AIP or hsCRP, the highest quartile of AIP (adjusted odds ratio, aOR 2.53, 95% CI: 1.90-3.38) and hsCRP (aOR 2.38, 1.79-3.16) was significantly associated with incident diabetes. The joint effects showed that participants with higher levels of AIP and hsCRP had significantly higher aOR of 2.76 (2.13-3.57). The LME models showed AIP and hsCRP were related to an increased level of fasting blood glucose and glycated hemoglobin. The combination of AIP and hsCRP has better predictive efficacy (area under the curve, AUC: 0.628, 0.601-0.654) for incident diabetes than alone. Mediation analyses showed that high AIP significantly mediated 25.4% of the association between hsCRP and diabetes, and hsCRP simultaneously mediated 5.7% of the association between AIP and diabetes.

CONCLUSIONS

This cohort suggests combined effects and mutual mediation between the AIP and hsCRP on incident diabetes in China. Our findings provide clinical implications for monitoring and managing AIP and hsCRP levels to mitigate the development of diabetes.

Emerging biomarkers in type 2 diabetes mellitus

Diabetes mellitus is a chronic condition caused by high blood glucose resulting from insufficient insulin production or cellular resistance to insulin action or both. It is one of the fastest-growing public health concerns worldwide. Development of long-term nephropathy, retinopathy, neuropathy, and cardiovascular disease are some of the complications commonly associated with poor blood glycemic control. Type 2 diabetes mellitus (T2DM), the most prevalent type of diabetes, accounts for around 95 % of all cases globally. Although middle-aged or older adults are more likely to develop T2DM, its prevalence has grown in children and young people due to increased obesity, sedentary lifestyle and poor nutrition. Furthermore, it is believed that more than 50 % of cases go undiagnosed annually. Routine screening is essential to ensure early detection and reduce risk of life-threatening complications. Herein, we review traditional biomarkers and highlight the ongoing pursuit of novel and efficacious biomarkers driven by the objective of achieving early, precise and prompt diagnoses. It is widely acknowledged that individual biomarkers will inevitably have certain limitations necessitating the need for integrating multiple markers in screening.

Predictive Capacity of Different Indicators of Adiposity for Metabolic Syndrome in Adults in the City of Trujillo, Peru

Background and Objectives: Various adiposity indicators have been used to predict metabolic syndrome (MetS). The aim of the present study was to evaluate the predictive ability of known adiposity indicators, such as abdominal girth, girth/height and fat percentage, as well as less commonly used indicators, such as the conicity index (CI), body roundness index (BRI), visceral adiposity index (VAI) and body shape index (ABSI), to predict MetS. Materials and Methods: A total of 261 participants, including family members and graduates of a flagship school in the city of Trujillo, Peru, participated. Metabolic syndrome was assessed according to the harmonised ATP III criteria. ROC curves were analysed for each of the adiposity indicators using SPSS 26.0 statistical software. Results: The prevalence of MetS was found to be 43.4%, with a higher proportion in men (25.8%). The area under the curve (AUC) for the prediction of MetS exceeded a value of 0.8 for VAI, abdominal circumference, circumference/height and relative fat mass in both men and women, with VAI showing the highest values of 0.858 and 0.875 in women and men, with cut-off points for MetS of 2.57 and 1.73, respectively. Conclusions: VAI can be used in the diagnosis of metabolic syndrome during lipid profile and anthropometric assessment.

Association between the atherogenic index of plasma and abdominal aortic calcification: results from the National Health and Nutrition Examination Survey 2013-2014

Background

Coronary artery calcification and cardiovascular disease are associated with elevated levels of atherogenic plasma index (AIP). However, the relationship with abdominal aortic calcification (AAC) remains unclear. This study aimed to explore the association between AIP and AAC using the National Health and Nutrition Examination Survey (NHANES) database.

Methods

A cross-sectional analysis was conducted on 2,811 individuals aged 40 years or older from the 2013-2014 NHANES dataset. Participants with missing AAC-24 scores, AIP data, or covariate information were excluded. AAC was quantified using the Kauppila score (AAC-24), with a score > 0 indicating the presence of AAC, and severe AAC (SAAC) being defined as an AAC-24 score ≥ 6. Multivariable regression models and restricted cubic spline analyses were employed to assess the associations between AIP and AAC. Sensitivity analysis was used to validate the robustness of the findings.

Results

The study population had a mean age of 57.7 years, with 48.22% being male. A significant positive association was found between AIP and both the AAC score and the risk of AAC and SAAC, particularly in females. For the overall population, each unit increase in AIP was associated with an overall increase in AAC-24 score of 0.90 (95% CI: 0.22, 1.58; p = 0.009), and for women, the AAC risk and SAAC risk would be 4.01-fold higher (95% CI: 1.65, 9.74; p = 0.002) and 9.37-fold higher (95% CI: 2.37, 37.03; p = 0.001). No significant associations were found in males. Further analysis revealed a significant interaction between AIP and gender regarding both AAC scores and the risk of SAAC.

Conclusions

This study demonstrates a positive relationship between AIP and increased AAC scores, as well as a higher risk of AAC and SAAC in U.S. women. However, these findings require further investigation to confirm the observed gender-specific differences.

Baseline atherogenic index of plasma and its trajectory predict onset of type 2 diabetes in a health screened adult population: a large longitudinal study

BACKGROUND

The Atherogenic Index of Plasma (AIP) is a novel biomarker for assessing the severity of atherosclerosis and has been shown to be closely associated with the risk of Type 2 Diabetes Mellitus (T2DM). However, no prospective cohort study has comprehensively evaluated both the immediate risk stratification through baseline AIP and the long-term risk assessment through multi-time point AIP trajectories in health screened adults in relation to T2DM risk.

METHODS

This longitudinal study included data from 42,850 participants who underwent health check-ups at Henan Provincial People's Hospital between January 2018 and August 2024. AIP was calculated as the logarithm of the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C). The Kaplan-Meier method was employed to analyze the incidence of T2DM across different AIP groups. A Cox model with restricted cubic splines assessed the dose-response relationship between AIP and T2DM risk, while latent class trajectory models (LCTM) evaluated the trends of AIP over multiple time points. Cox proportional hazards models were used to examine the relationship between baseline AIP quartiles, AIP trajectories, and T2DM risk.

RESULTS

During an average follow-up of 47.95 months, 3,228 participants developed T2DM. Stratifying by baseline AIP quartiles revealed that higher AIP levels were associated with an increased risk of T2DM. Compared to the lowest quartile, the highest quartile had a hazard ratio (HR) of 2.10 (95% CI: 1.74, 2.53). The LCTM identified three trajectory patterns for AIP: with the low-stable group as the reference, the medium-stable and high-stable groups had HRs of 1.72 (95% CI: 1.50, 1.96) and 2.50 (95% CI: 2.06, 3.03), respectively, indicating a significantly elevated risk of T2DM (P < 0.05).

CONCLUSION

Elevated baseline AIP levels, medium stable trajectories and high stable trajectories are associated with an increased risk of T2DM in health screened adults.

Lymphocyte to High-density Lipoprotein Cholesterol Ratio is Positively Associated with Pre-diabetes, Metabolic Syndrome, and Non-traditional Cardiometabolic Risk Markers: A Cross-sectional Study at Secondary Health Care

High scores of lymphocyte-to-high-density lipoprotein cholesterol ratio (lymphocyte-to-HDL-c) may be a new indicator of inflammation and metabolic syndrome. Here, we investigated the associations of the lymphocyte-to-HDL-c with traditional and non-traditional cardiometabolic risk markers in subjects at high cardiovascular risk. This study is a cross-sectional analysis with subjects assisted in a Secondary Health Care (n = 581, age = 63.06 ± 13.86 years; 52.3% women). Lymphocyte-to-HDL-c ratio were assessed by routine laboratory tests. Anthropometric and/or biochemical variables were used to calculate traditional (body mass index - BMI, and waist-to-height ratio - WHtR) and non-traditional (lipid accumulation product index-LAP, visceral adiposity index-VAI, deep-abdominal-adipose-tissue index-DAAT, atherogenic index of plasma-AIP, and waist-hypertriglyceridemic phenotype-HTGW) cardiometabolic risk markers. Furthermore, anthropometric measurement waist circumference (WC), blood pressure, metabolic syndrome (MS), and biochemical markers (lipid and glycemic profile) were considered traditional markers of cardiometabolic risk. Pearson's chi-square test, Poisson regression with robust variance, or multinomial logistic regression were performed (α = 0.05). Individuals with a high lymphocyte-HDL-c ratio (> 0.84, 3rd tertile) were associated with the HTGW phenotype, high VAI, high LAP, hypertriglyceridemia, high AIP, high very low-density lipoprotein-cholesterol (VLDL-c), pre-diabetes, and 3 and 4 MS components compared with individuals in the first tertile, independent of confounders. Our findings supported the lymphocyte-to-HDL-c ratio as a potential biomarker during the screening of subjects at high cardiovascular risk.

Association between the atherogenic index of plasma and long-term risk of type 2 diabetes: a 12-year cohort study based on the Japanese population

BACKGROUND

Atherosclerotic dyslipidemia is associated with an increased risk of type 2 diabetes (T2D). Although previous studies have demonstrated an association between the atherogenic index of plasma (AIP) and insulin resistance, there remains a scarcity of large cohort studies investigating the association between AIP and the long-term risk of T2D in the general population. This study aims to investigate the potential association between AIP and the long-term risk of T2D in individuals with normal fasting plasma glucose levels.

METHODS

This retrospective cohort study included 15,453 participants. The AIP was calculated using the formula log [triglyceride (mmol/L)/high-density lipoprotein cholesterol (mmol/L)]. Cox proportional hazard regression models were employed to assess the association between AIP and T2D risk. The nonlinear association was examined using a restricted cubic spline (RCS) model.

RESULTS

During an average follow-up period of 6.05 years, 373 participants developed T2D. After adjusting for confounding factors, elevated AIP was independently associated with an increased risk of developing T2D (HR 1.763, 95%CI 1.210-2.568, P = 0.003). The RCS analysis revealed a J-shaped association between AIP and T2D risk, with a sharp increase in risk when AIP levels exceeded - 0.268. Moreover, time-dependent receiver operating characteristic analysis consistently demonstrated a moderate predictability of AIP for new-onset T2D within 1 to 12 years.

CONCLUSION

The AIP exhibits a J-shaped association with the risk of developing T2D. Therefore, maintaining AIP levels below a certain threshold (-0.268) might help prevent the onset of T2D.

Nonlinear association between atherogenic index of plasma and chronic kidney disease: a nationwide cross-sectional study

BACKGROUND

The interplay between metabolic disorders and chronic kidney disease (CKD) has been well-documented. However, the connection between CKD and atherogenic index of plasma (AIP) remains understudied. This research delves into the correlation between these two factors, aiming to shed new light on their potential association.

METHODS

The relationship between AIP and CKD was evaluated using a weighted multivariate logistic regression model, and the curvilinear relationship between AIP and CKD was explored through smooth curve fitting. We engaged a recursive partitioning algorithm in conjunction with a two-stage linear regression model to precisely determine the inflection point. By conducting stratified analyses, the heterogeneity within subpopulations was explored.

RESULTS

In the regression model that accounted for all covariates, ORs (95% CI) for the association between CKD and AIP were 1.12 (0.91, 1.36), indicating no significant association between AIP and CKD. However, sensitivity analyses suggested that the relationship between them may be non-linear. Smooth curve analysis confirmed the non-linear relationship between AIP and CKD, identifying an inflection point at -0.55. Below this threshold, AIP exhibited a significant inverse correlation with CKD. Conversely, above this threshold, a pronounced positive correlation was detected. Stratified analyses elucidated that a non-linear association between AIP and CKD was observed among female participants and those aged 50 and above.

CONCLUSION

We found a curvilinear relationship between chronic kidney disease and atherogenic index of plasma.

The Antioxidant Potential of Vitamins and Their Implication in Metabolic Abnormalities

Vitamins are micronutrients necessary for the normal function of the body. Although each vitamin has different physicochemical properties and a specific role in maintaining life, they may also possess a common characteristic, i.e., antioxidant activity. Oxidative stress can harm all the main biological structures leading to protein, DNA and lipid oxidation, with concomitant impairment of the cell. It has been established that oxidative stress is implicated in several pathological conditions such as atherosclerosis, diabetes, obesity, inflammation and metabolic syndrome. In this review we investigate the influence of oxidative stress on the above conditions, examine the interrelation between oxidative stress and inflammation and point out the importance of vitamins in these processes, especially in oxidative load manipulation and metabolic abnormalities.

Visit to visit transition in TXNIP gene methylation and the risk of type 2 diabetes mellitus: a nested case-control study

Our study aimed to investigate the association between the transition of the TXNIP gene methylation level and the risk of incident type 2 diabetes mellitus (T2DM). This study included 263 incident cases of T2DM and 263 matched non-T2DM participants. According to the methylation levels of five loci (CpG1-5; chr1:145441102-145442001) on the TXNIP gene, the participants were classified into four transition groups: maintained low, low to high, high to low, and maintained high methylation levels. Compared with individuals whose methylation level of CpG2-5 at the TXNIP gene was maintained low, individuals with maintained high methylation levels showed a 61-87% reduction in T2DM risk (66% for CpG2 [OR: 0.34, 95% CI: 0.14, 0.80]; 77% for CpG3 [OR: 0.23, 95% CI: 0.07, 0.78]; 87% for CpG4 [OR: 0.13, 95% CI: 0.03, 0.56]; and 61% for CpG5 [OR: 0.39, 95% CI: 0.16, 0.92]). Maintained high methylation levels of four loci of the TXNIP gene are associated with a reduction of T2DM incident risk in the current study. Our study suggests that preserving hypermethylation levels of the TXNIP gene may hold promise as a potential preventive measure against the onset of T2DM.

Gender differences in the association between changes in the atherogenic index of plasma and cardiometabolic diseases: a cohort study

OBJECTIVE

The relationship between changes in Atherogenic Index of Plasma (AIP) and cardiometabolic diseases (CMD) in middle-aged and elderly individuals remains unclear. This study aims to explore the association between changes in AIP and CMD.

METHODS

This study included 3,791 individuals aged over 45 years from CHARLS. Participants were divided into four groups using the K-Means clustering method. Cumulative AIP was used as a quantitative indicator reflecting changes in AIP. Differences in baseline data and CMD incidence rates among these four groups were compared. Multifactorial logistic regression models were used to assess the relationship between changes in AIP and CMD, and subgroup analysis and interaction tests were conducted to evaluate potential relationships between changes in AIP and CMD across different subgroups. Restricted cubic splines (RCS) were used to assess the dose-response relationship between cumulative AIP and CMD.

RESULTS

Changes in AIP were independently and positively associated with CMD. In males, the risk significantly increased in class4 compared to class1 (OR 1.75, 95%CI 1.12-2.73). In females, changes in AIP were not significantly associated with CMD. Cumulative AIP was positively correlated with CMD (OR 1.15, 95%CI 1.01-1.30), with significant gender differences in males (OR 1.29, 95%CI 1.07-1.55) and females (OR 1.03, 95%CI 0.87-1.23) (p for interaction = 0.042). In addition, a linear relationship was observed between cumulative AIP and CMD in male.

CONCLUSION

Substantial changes in AIP may increase the risk of CMD in middle-aged and elderly Chinese males. Dynamic monitoring of AIP is of significant importance for the prevention and treatment of CMD.

Association between visceral adiposity index and risk of diabetes and prediabetes: Results from the NHANES (1999-2018)

OBJECTIVE

To investigate the association between the visceral adiposity index and the prevalence of diabetes and prediabetes in the US adult population.

METHOD

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 for ten consecutive years, including 18745 eligible participants. The weighted multivariate logistic model and fitting curve were used to explore the correlation and dose-response relationship between visceral adiposity index (VAI) and diabetes (DM) and prediabetes in the general population and the prevalence of different subgroups.

RESULTS

In the fully adjusted continuous model, the risk of diabetes and prediabetes in the general population increased 0.15 times [1.15 (1.10,1.20), p<0.0001] with every increase of 1 unit of VAI. In the fully adjusted classification model, with the lowest quartile array Q1 of VAI as the reference group, Q2 of the second Quantile group, Q3 of the third Quantile group, and Q4 of the Quartile group increased 0.26 times [1.26 (1.10,1.44), p<0.001], 0.65 times [1.65 (1.43,1.89), p<0.0001], 1.60 times [2.60 (2.28,2.97), p<0.0001] respectively with the risk of diabetes and prediabetes. The above results showed that VAI was positively associated with the prevalence of diabetes and prediabetes, and the fitted curves showed a non-linear trend. (P for non-linear = 0<0.05). The results of the subgroup population were consistent with the total population and a significant interaction was found in gender (P for interaction<0.0001).

CONCLUSION

In conclusion, we found a non-linear positive association between VAI and the risk of diabetes and prediabetes in the US adult population and found that women have a higher risk of diabetes and prediabetes than men; therefore, we should focus on the female population, and we call for the use of VAI to manage the development of diabetes and prediabetes in the clinical setting.

Correlation analysis of diabetes based on Copula

Introduction

The ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) is a crucial indicator for diabetes diagnosis.

Methods

This study utilizes the Copula function to model and fit the non-linear correlation among fasting blood glucose (Glu), glycosylated hemoglobin (HbA1C), and TG/HDL-C in patients with diabetes. The Copula function chosen for this study includes the two-dimensional Archimedes and Elliptical distribution family, as well as the multidimensional Vine Copula function, for fitting the data. The evaluation of the fitting effect is performed using the mean absolute error (MAE) and mean square error (MSE).

Results

The results indicate that the Clayton Copula exhibits the highest effectiveness in fitting the pairwise relationship between Glu and TG/HDL-C, as well as HbA1C and TG/HDL-C, displaying the smallest fitting error. Additionally, the Vine Copula function produces a satisfactory fit for the relationship among all three indicators. Compared to linear analysis methods, the Copula function more accurately depicts the correlation among these three types of indicators.

Discussion

Moreover, our findings indicate a stronger correlation in the lower tail between Glu and HbA1C, as well as TG/HDL-C, suggesting that the Copula function provides greater accuracy and applicability in depicting the relationship among these indicators. As a result, it can offer a more precise auxiliary diagnosis and serve as a valuable reference in clinical judgment.

Association between circulating biomarkers and non-alcoholic fatty liver disease: An integrative Mendelian randomization study of European ancestry

BACKGROUND AND AIM

Circulating biomarkers provide potential diagnostic or prognostic information on disease presentation, progression or both. Early detection of circulating risk biomarkers is critical for non-alcoholic fatty liver disease (NAFLD) prevention. We aimed to systematically assess the potential causal relationship of genetically predicted 60 circulatory biomarkers with NAFLD using a two-sample Mendelian randomization (MR) design.

METHODS AND RESULTS

We extracted instrumental variables for 60 circulating biomarkers, and obtained genome-wide association data for NAFLD from 3 sources [(including Anstee, FinnGen and UK Biobank (N ranges: 19264-377988)] among individuals of European ancestry. Our primary method was inverse-variance weighted (IVW) MR, with a series of additional and sensitivity analyses to test the hypothesis of MR. MR results showed that genetically predicted higher density lipoprotein-cholesterol (odds ratio (OR) = 0.86, 95% confidence interval (CI): 0.77-0.96) and vitamin D (OR = 0.39, 95% CI: 0.19-0.78) levels decreased the risk of NAFLD, whereas genetically predicted higher alanine (OR = 1.68, 95% CI: 1.21-2.33), histidine (OR = 1.21, 95% CI: 1.00-1.46), lactate (OR = 2.64, 95% CI: 1.09-6.39), triglycerides (OR = 1.16, 95% CI: 1.05-1.13), ferritin (OR = 1.17, 95% CI: 1.01-1.37), serum iron (OR = 1.23, 95% CI: 1.07-1.41) and transferrin saturation (OR = 1.16, 95% CI: 1.05-1.29), component 4 (OR = 1.10, 95% CI: 1.01-1.20), interleukin-1 receptor antagonist (OR = 1.12, 95% CI: 1.04-1.21) and interleukin-6 (OR = 1.62, 95% CI: 1.14-2.30) levels increased the risk of NAFLD.

CONCLUSIONS

The findings might aid in elucidating the underlying processes of these causal relationships and provide strong evidence for focusing on high-risk populations and the therapeutic management of specific biomarkers.

The Impact of Comorbidities and Demographic Factors on Ejection Fraction

Heart failure (HF) presents an increasingly significant problem as the population ages. The cause of HF plays a significant role in determining treatment options and outcomes. It is worth noting that several studies have identified gender disparities in both morbidity and mortality, which may suggest differing causes of HF. The purpose of this research is to investigate the influence of various factors, including demographics and comorbidities, on ejection fraction (EF). The objectives of this study involve implementing preventive measures, ensuring timely diagnosis, and implementing interventions that target risk factors and specific comorbidities. These efforts aim to improve the prognosis for individuals affected by heart failure. The main method consists of linear regression. The demographic factors under scrutiny are gender and education, while the comorbidities of interest encompass valvulopathy, ischemia, smoking, obesity, high cholesterol, and diabetes. The main results consist of the fact that high education is associated with a 12.8% better EF on average, while among the factors with a negative role analyzed, ischemia is the most harmful, being 12.8% lower on average. Factors with a smaller impact are smoking, obesity, and high cholesterol. Diabetes does not seem to affect EF.

Comparative effects of acupuncture and metformin on insulin sensitivity in overweight/obese and lean women with polycystic ovary syndrome and insulin resistance: a post hoc analysis of a randomized trial

Objective

This study explored the efficacy of acupuncture and metformin in enhancing insulin sensitivity among women with polycystic ovary syndrome (PCOS) and insulin resistance (IR), distinguishing between overweight/obese and lean groups.

Methods

A post-hoc analysis of a randomized trial (NCT02491333) was undertaken. Participants were women aged 18-40 with PCOS and IR. They were randomized to receive true acupuncture with a placebo, metformin with sham acupuncture, or sham acupuncture with a placebo for 4 months, with follow-up visits over 3 months. Our study, involving 339 women, assessed the differential impact of acupuncture and metformin on insulin sensitivity in overweight/obese [body mass index (BMI) ≥ 24] versus lean women (BMI < 24). Primary outcomes measured changes in the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) at 4 and 7 months. Secondary outcomes assessed changes in glucose area under the curve (glucoseAUC) during the oral glucose tolerance test (OGTT) and BMI changes at 4 months.

Results

Overweight/obese participants were generally older with higher measurements in various health metrics, but lower levels in specific hormonal metrics compared to lean women (p < 0.05). Among overweight/obese women, metformin outperformed acupuncture in reducing HOMA-IR levels (p = 0.004) and showed a significant drop from the baseline after 4 months (p < 0.05). In contrast, acupuncture's effect on HOMA-IR did not significantly differ from sham acupuncture at 4 and 7 months. For lean women, metformin and acupuncture showed comparable improvements in HOMA-IR, with notable declines at 4 and 7 months (p < 0.05). Acupuncture proved more beneficial for lean women than their overweight/obese counterparts after 4 months (p = 0.021).

Conclusion

In overweight/obese women with PCOS and IR, acupuncture was less effective than metformin in enhancing insulin sensitivity. However, in lean women, acupuncture's efficacy was comparable to metformin. Further studies are required to validate these observations.

Total bilirubin and bilirubin-to-triglycerides ratio predict changes in glycated hemoglobin in healthy children

Objective

Bilirubin and triglycerides can regulate insulin secretion and glucose uptake. The aim of our study is to analyze associations between total bilirubin (TB) and the bilirubin-to-triglycerides ratio (BTR) with metabolic markers in healthy prepubertal children.

Methods

Subjects were 246 healthy children (mean age 8), of whom 142 (58%) were reevaluated 4 years later (mean age 12). The subjects were stratified according to age into three groups (<7.8 years; 7.8-9.6 years; and >9.6 years; n=82 each) at baseline and into two groups (<12.9 years and ≥12.9 years; n=71 each) at follow-up. Anthropometrics and laboratory parameters [TB and its fractions (direct and indirect bilirubin), triglycerides, HDL-cholesterol, glucose, insulin, HOMA-IR, HOMA-B and glycated hemoglobin (HbA1c)] were assessed at both baseline and follow-up.

Results

TB and BTR showed independent and negative association with baseline and follow-up HbA1c. These associations were stronger for BTR and in the highest age group. No independent associations were observed with HOMA-IR or HOMA-B.

Conclusion

TB and BTR are independently associated with HbA1c and predict its changes over time in healthy children. Our results indicate that TB and BTR may be useful parameters in studies of glucose tolerance in healthy children.

Triglycerides/HDL cholesterol ratio and type 2 diabetes incidence: Panasonic Cohort Study 10

BACKGROUND

Previous studies have investigated the association between the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) and the incidence of diabetes in adults and discovered that a high TG/HDL-C ratio was linked to an elevated risk of new-onset diabetes. However, the comparison of predicting diabetes development among lipid profiles including the TG/HDL-C ratio, and the ratio of TG/HDL-C cut-off value has received limited attention. We examined the relationship between diabetes onset and the TG/HDL-C ratio in addition to the applicable cut-off value for predicting diabetes onset.

METHODS

This study included 120,613 participants from the health examination database at Panasonic Corporation from 2008 to 2017. Cox regression analysis employing multivariable models was used to investigate the association between lipid profiles, particularly the ratio of TG/HDL-C and the development of type 2 diabetes (T2D). The multivariable model was adjusted for age, sex, BMI, systolic blood pressure, plasma glucose levels after fasting, smoking status, and exercise habits. Areas under time-dependent receiver operating characteristic (ROC) curves (AUCs) were employed to assess the prediction performance and cut-off values of each indicator. A fasting plasma glucose level of 126 mg/dL, a self-reported history of diabetes, or usage of antidiabetic medicines were used to identify T2D.

RESULTS

During the course of the study, 6,080 people developed T2D. The median follow-up duration was 6.0 (3-10) years. Multivariable analysis revealed that the ratio of TG/HDL-C (per unit, HR; 1.03 [95% CI 1.02-1.03]) was substantially linked to the risk of incident T2D. AUC and cut-off points for the ratio of TG/HDL-C for T2D development after 10 years were 0.679 and 2.1, respectively. Furthermore, the AUC of the ratio of TG/HDL-C was considerably larger compared to that of LDL-C, HDL-C, and TG alone (all P < 0.001). We discovered an interaction effect between sex, BMI, and lipid profiles in subgroup analysis. Females and participants having a BMI of < 25 kg/m2 showed a higher correlation between lipid profile levels and T2D onset.

CONCLUSIONS

The ratio of TG/HDL-C was found to be a stronger predictor of T2D development within 10 years than LDL-C, HDL-C, or TG, indicating that it may be useful in future medical treatment support.

The role of fibrinolysis in the development of prediabetes-associated coronary heart disease: a focus on the plasminogen activator inhibitor -1 and its potential use as a predictive marker in diet-induced prediabetes

Introduction

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular diseases (CVD). However, the onset of T2DM is preceded by prediabetes, which is associated with sedentary lifestyles and consumption of high-calorie diets. Studies have shown that impaired glucose homeostasis creates an environment for developing T2DM-related complications. Using a high-fat-high-carbohydrate diet-induced prediabetes animal model, this study sought to assess the risk factors of coronary heart disease (CHD) in diet-induced prediabetes and identify biomarkers that can be used for early detection of prediabetes-associated CHD.

Methods

Male Sprague Dawley rats were randomly grouped into two groups and were kept on different diets for 20 weeks (n = 6 in each group). One group was fed standard rat chow to serve as a non-prediabetes (NPD) control, while the other group consumed a high-fat-high-carbohydrate diet to induce prediabetes (PD). Post induction, the homeostasis model assessment- insulin resistance (HOMA-IR) and glycated haemoglobin (HbA1c) was used to test for insulin resistance. Body weight, mean arterial pressure (MAP), resting heart rate (HR), inflammatory cytokines (C-reactive protein (CRP), tumor necrosis factor (TNF-α), interleukin-6 (IL-6)), lipids (total cholesterol (TC), triglyceride (TG), lipoproteins (HDL, LDL, VLDL)), endothelial function (endothelial nitric oxide (eNOS), endothelin -1 (ET-1)), fibrinolysis (plasminogen activator inhibitor-1 (PAI-1)) were all measured to assess the risk of CHD. All data were expressed as means ± S.E.M. Statistical comparisons were performed with Graph Pad. Instat Software using Student's two-sided t-test. The Pearson correlation coefficient and linear regression were calculated to assess the association. The value of p < 0.05 was considered statistically significant.

Results

There was significant insulin resistance accompanied by significantly increased HbA1c and body weight in PD compared to NPD. Simultaneously, there was a significant increase in inflammatory cytokines in PD compared to NPD. This was accompanied by significantly increased TG and VLDL and endothelial dysfunction in PD. The association between HOMA-IR and PAI-1 was insignificantly positive in NPD, whereas a significantly strong positive association was observed in PD.

Conclusion

There is a positive correlation between insulin resistance and PAI-1 during prediabetes; therefore, suggesting that prediabetes increases the risk of developing vascular thrombosis. The current therefore study warrants further investigation on PAI-1 and other markers of fibrinolysis for the early detection of thrombosis and risk of CHD in prediabetes.

Novel Associations of Dyslipidaemia with Vitamin D and Bone Metabolism in Elderly Patients with Diabetes: A Cross-Sectional Study

Objective

Little is known about whether diabetic dyslipidaemia contributes to increased bone fragility in patients with diabetes. This study aimed to explore the potential effects of dyslipidaemia on vitamin D and bone metabolism in elderly subjects with type 2 diabetes (T2D).

Methods

A total of 1479 male patients and 1356 female patients 50 years or older with T2D were included in Shanghai, China. Lipid profiles, 25-hydroxyvitamin D (25(OH)D), serum procollagen type I N-terminal propeptide (P1NP), β-C-terminal telopeptide (β-CTX) and other parameters were measured. Principal component regression (PCR) and mediation analysis were used to estimate the associations of lipid profile, 25(OH)D and bone turnover levels.

Results

Female patients presented with higher blood lipids, lower 25(OH)D, and higher P1NP and β-CTX levels than male patients with T2D. TC was associated with P1NP in males and females (β=0.056, P<0.05; β=0.095, P<0.01, respectively), and 25(OH)D fully mediated the associations in males and mediated approximately 17.89% of the effects in females. LDL-C was associated with P1NP in males and females (β=0.072 and 0.105 respectively, all P<0.01), and 25(OH)D mediated the relationships approximately 20.83% in males and 14.29% in females. TG was negatively associated with P1NP (in males, β= -0.063, P<0.05; in females, β= -0.100, P<0.01) and β-CTX (in males, β= -0.108; in females, β= -0.128, all P<0.01) independent of 25(OH)D, while HDL-C was not associated with P1NP or β-CTX in diabetic patients.

Conclusion

Hypercholesterolemia and hypertriglyceridaemia might affect bone metabolism by distinguishing pathways in diabetes patients. Ameliorating lipid control in elderly diabetes patients, especially female patients, will benefit both vitamin D and bone metabolism.

A U-shaped association between the triglyceride to high-density lipoprotein cholesterol ratio and the risk of incident type 2 diabetes mellitus in Japanese men with normal glycemic levels: a population-based longitudinal cohort study

Background

Several studies have verified that a high baseline TG/HDL-C ratio is a risk factor for incident type 2 diabetes mellitus (T2DM). However, for low baseline TG/HDL-C levels, the findings were inconsistent with ours. In addition, the association between baseline TG/HDL-C ratio and the risk of incident T2DM in Japanese men with normal glycemic levels is unclear. As a result, our study further investigated the relationship between baseline TG/HDL-C and the risk of incident T2DM in Japanese men with normal glycemic levels.

Methods

This was a secondary longitudinal cohort study. We selected 7,684 male participants between 2004 and 2015 from the NAGALA database. A standardized Cox regression model and two piecewise Cox regression models were used to explore the relationship between the baseline high-density lipoprotein cholesterol ratio (TG/HDL-C) and incident T2DM.

Results

During a median follow-up of 2,282 days, 162 men developed incident T2DM. In the adjusted model, the baseline TG/HDL-C ratio was strongly associated with the risk of incident T2DM, and no dose-dependent positive association was observed between the baseline TG/HDL-C ratio and incidence of T2DM throughout the baseline TG/HDL-C quartiles. Two-piecewise linear regression analysis showed a U-shaped association between baseline TG/HDL-C ratio and incidence of incident T2DM. A baseline TG/HDL-C ratio below 1.188 was negatively associated with incident T2DM (H.R. = 0.105, 95% CI = 0.025, 0.451; P = 0.002). In contrast, a baseline TG/HDL-C ratio >1.188 was positively associated with incident T2DM (H.R. = 1.248, 95% CI = 1.113, 1.399; P<0.001). The best TG/HDL-C threshold for predicting incident T2DM was 1.8115 (area under the curve, 0.6837).

Conclusion

A U-shaped relationship between baseline TG/HDL-C ratio and incident T2DM in Japanese men with normal glycemic levels was found.

Longitudinal trajectories of atherogenic index of plasma and risks of cardiovascular diseases: results from the Korean genome and epidemiology study

BACKGROUND

Although the atherogenic index of plasma (AIP) based on a single measurement is a known risk factor for cardiovascular disease (CVD), little is known about whether changes in AIP over time are related to incident CVD. We aimed to determine whether AIP trajectory, which reflects homogenous AIP trends for a particular period, is associated with CVD risk.

METHODS

Data from 5,843 participants of the Korean Genome and Epidemiology Study (KoGES) were analyzed. The KoGES had been conducted biennially from the baseline survey (2001-2002) to the eighth follow-up survey (2017-2018). The research design specifies the exposure period from baseline to the third follow-up, designates the latent period at the fourth follow-up, and establishes the event accrual period from the fifth to the eighth follow-up. During the exposure period, we identified two trajectories: a decreasing (n = 3,036) and an increasing group (n = 2,807) using latent variable mixture modeling. Information on CVD was collected initially through the self-reporting, followed by in depth person-to-person interview conducted by a well-trained examiner. During the event accrual period, the cumulative incidence rates of CVD between the two AIP trajectory groups were estimated using Kaplan-Meier analysis with the log-rank test. Multiple Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

The increasing AIP trajectory group had a significantly higher cumulative incidence rate of CVD than the decreasing AIP trajectory group. Compared to the decreasing AIP trajectory group, the increasing AIP trajectory group had a higher risk of incident CVD (HR: 1.31, 95% CI: 1.02-1.69) after adjusting for confounders.

CONCLUSIONS

The risk of incident CVD increased when the AIP level showed an increasing trend and remained high over a long period. This suggests that checking and managing the trajectory of the AIP can be a preventive strategy for incident CVD.

Risk factors of nonalcoholic fatty liver disease in healthy women

We investigated the risk factors of nonalcoholic fatty liver disease (NAFLD) in healthy women. This is a cross-sectional study. Healthy women who underwent physical examination were enrolled. Their basic information and medical history [including age, height, weight, body mass index (BMI)], abdominal ultrasound results, and, serological indexes [including white blood cells, platelet count, fasting blood glucose, triglyceride (TG), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDLC), uric acid (UA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and glutamyl transpeptidase] were collected. Univariate and multivariate regression analysis was carried out to screen the risk factors of NAFLD. ALT/AST ratio, and BMI were significantly independent risk factors for the occurrence and severity of NAFLD. In addition, TG/HDLC ratio, and UA level also had significant independent correlation with NAFLD. ALT/AST ratio, BMI, TG/HDLC ratio, and UA are independent risk factors for the occurrence and severity of NAFLD. It is suggested that obesity, hyperlipidemia, hyperuricemia and high transaminase value are closely related to NAFLD. People with such conditions should pay more attention to early screening of NAFLD to avoid disease aggravation and the occurrence and development of other complications. In clinical practice, ALT/AST, BMI, TG/HDLC, and UA level should be closely monitored, so as to facilitate the follow-up management of the disease.

Evaluation of levels of uric acid and lipid profile in hospitalized patients with diabetes

OBJECTIVE

Diabetes is the most common metabolic disorder that leads to various complications, and among these complications, disruption in the lipid profile and serum uric acid (SUA) is one of the significant cases that can lead to the deterioration of the health status of patients with diabetes. So, we aimed to evaluate the level of SUA and lipid profiles in patients with diabetes. A total of 230 patients with diabetes who were admitted to Razi Hospital, Rasht, Iran, were enrolled in this study. Demographical data and clinical characteristics of the patients include gender, body mass index (BMI), duration of diabetes, history of smoking, FBS, HbA1c, SUA, Creatinine (Cr), Cholesterol (Chol), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), retinopathy, hypertension, ischemic heart disease (IHD), and microalbuminuria were recorded. All data were analyzed using the SPSS version 21 by a significant level < 0.05.

RESULT

According to our results, 70 were male, and 160 were female, with a mean age of 57.36 ± 8.05 years and a mean BMI of 28.10 ± 4.62. The most frequent comorbidities were hypertension, 67%. The serum level of FBS, HBA1c, SUA, Cr, Chol, LDL, HDL, and TG were 191.47 ± 71.66 mg/dL, 7.94 ± 1.21 mg/dL, 5.65 ± 1.95 mg/dL, 0.94 ± 0.16 mg/dL, 167.28 ± 45.22 mg/dL, 95.91 ± 37.03 mg/dL, 39.78 ± 10.44 mg/dL, and 186.75 ± 76.65 mg/dL, respectively. Only UA had a significant relationship with TG level (P < 0.05).

Biochemical association of regulatory variant of KLF14 genotype in the pathogenesis of cardiodiabetic patients

Background and purpose

The study focuses on examining the relationship between a single nucleotide polymorphism (SNP) in KLF14 rs4731702 and risk of type 2 diabetes mellitus (T2DM) and dyslipidemia in different ethnic populations. The purpose of this study was to evaluate the association between KLF14 rs4731702 and serum lipid profile and to determine the frequency distribution of KLF14 rs4731702 among T2DM and cardiometabolic patients.

Methods

A total of 300 volunteers were recruited, consisting of three groups: 100 healthy individuals, 100 individuals diagnosed with T2DM, and 100 individuals diagnosed with cardiometabolic disorders. Biochemical analysis of blood samples was conducted to assess various biomarkers related to glycemic control and lipid profile. This involved measuring levels of glucose, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and ApoA1. Genotyping analysis was performed to investigate KLF14 rs4731702 polymorphism. The Tetra ARMS-PCR method was employed for genotyping analysis.

Results

The results of biochemical profiling revealed a significant association between altered glycemic biomarkers and lipid profile in diseased patients compared to healthy participants. The frequencies of KLF14 rs4731702 alleles and genotypes were compared between the control group and T2DM group. A statistically significant difference was observed, indicating a potential association between KLF14 rs4731702 and T2DM. In the dominant inheritance model of KLF14 rs4731702 SNP, a statistically significant difference [odds ratio (95% confidence interval)] of 0.56 (0.34 -0.96) was found between the control and T2DM subjects. This suggests that the presence of certain genotypes influences the risk of T2DM. In T2DM patients, individuals carrying the C allele exhibited compromised insulin sensitivity, decreased HDL-C and ApoA1 levels, and increased serum glucose, TG, and LDL-C concentrations. Conversely, TT genotype carriers demonstrated increased levels of HDL-C and ApoA1, lower insulin resistance, serum glucose, LDL-C, and TG levels.

Conclusion

The study's findings indicate that dyslipidemia in T2DM patients is associated with reduced KLF14 functionality due to CC and CT genotypes, leading to insulin resistance and an increased risk of cardiovascular diseases. Additionally, risk of KLF14 rs4731702 polymorphism was found to increase with age and was more prevalent in female than in male individuals. These insights contribute to understanding genetic factors influencing the development and progression of T2DM and dyslipidemia in different ethnic populations.

Sex-Specific Models to Predict Insulin Secretion and Sensitivity in Subjects with Overweight and Obesity

Sex-specific differences exist in insulin secretion (ISec) and sensitivity (IS) in humans. However, current fasting indices used to estimate them, such as HOMA and QUICKI, are not sex-specific. We aimed to develop sex-specific models to improve the prediction of ISec and IS by fasting measures in adults with overweight/obesity. A post hoc analysis was conducted on baseline data of two clinical trials completed between 2010 and 2020 (37 men and 61 postmenopausal women, 45-73 years, BMI > 25 kg/m², without chronic disease). Glucose-induced insulin or C-peptide secretions and IS were measured using gold-standard Botnia-clamps, which is a 1 h intravenous glucose tolerance test followed by a 3 h hyperinsulinemic-euglycemic clamp. Stepwise regression analysis using anthropometric and fasting plasma glucose, insulin, and lipoprotein-related measures was used to predict ISec and IS. First-phase, second-phase and total glucose-induced ISec were predicted by a combination of fasting plasma insulin and apoB without or with plasma glucose, triglyceride, and waist circumference in women (R² = 0.58-0.69), and by plasma insulin and glucose without or with BMI and cholesterol in men (R² = 0.41-0.83). Plasma C-peptide, alone in men or followed by glucose in women, predicted C-peptide secretion. IS was predicted by plasma insulin and waist circumference, followed by HDL-C in women (R² = 0.57) or by glucose in men (R² = 0.67). The sex-specific models agreed with the Botnia-clamp measurements of ISec and IS more than with HOMA or QUICKI. Sex-specific models incorporating anthropometric and lipoprotein-related parameters allowed better prediction of ISec and IS in subjects with overweight or obesity than current indices that rely on glucose and insulin alone.

Association between triglyceride to high-density lipoprotein cholesterol ratio and type 2 diabetes risk in Japanese

Abnormal lipid metabolism is known to increases the risk for metabolic diseases, such as type 2 diabetes mellitus(T2DM). The relationship between baseline ratio of triglyceride to HDL cholesterol (TG/HDL-C) and T2DM in Japanese adults was investigated in this study. Our secondary analysis included 8419 male and 7034 female Japanese subjects who were free of diabetes at baseline. The correlation between baseline TG/HDL-C and T2DM was analyzed by a proportional risk regression model, the nonlinear correlation between baseline TG/HDL-C and T2DM was analyzed by a generalized additive model (GAM), and the threshold effect analysis was performed by a segmented regression model. We conducted subgroup analyses in different populations. During the median 5.39 years follow-up, 373 participants, 286 males and 87 females, developed diabetes mellitus. After full adjustment for confounders, the baseline TG/HDL-C ratio positively correlated with the risk of diabetes (hazard ratio 1.19, 95% confidence interval 1.09-1.3), and smoothed curve fitting and two-stage linear regression analysis revealed a J-shaped relationship between baseline TG/HDL-C and T2DM. The inflection point for baseline TG/HDL-C was 0.35. baseline TG/HDL-C > 0.35 was positively associated with the development of T2DM (hazard ratio 1.2, 95% confidence interval 1.10-1.31). Subgroup analysis showed no significant differences in the effect between TG/HDL-C and T2DM in different populations. A J-shaped relationship was observed between baseline TG/HDL-C and T2DM risk in the Japanese population. When TG/HDL-C was higher than 0.35, there was a positive relationship between baseline TG/HDL-C and the incidence of diabetes mellitus.

Sex-specific differences in the effect of the atherogenic index of plasma on prediabetes and diabetes in the NHANES 2011-2018 population

BACKGROUND

Although a great deal of scientific evidence on the epidemiological risk factors for diabetes and prediabetes has been accumulated, there is still insufficient evidence to explore sex-related differences. The aim of this study was to examine sex-specific differences in the effect of the atherogenic index of plasma (AIP) on prediabetes and diabetes.

METHODS

This cross-sectional study included data from 10099 American adults. The exposure variable was the AIP, which was defined as log10 (triglycerides/high-density lipoprotein cholesterol). The outcome variables included prediabetes and diabetes defined by the 2013 American Diabetes Association guidelines.

RESULTS

The median age (mean ± SD) was 48.51 ± 18.42 years, and the average value (SD) of the AIP was - 0.09 (0.34). The prevalence of prediabetes was 40.24%, and that of diabetes was 21.32%. Overall, there was a significant positive association between the AIP and prediabetes and diabetes (per 1-unit increment in the AIP: OR, 2.49; 95% CI 1.75, 3.54). The multivariate logistic regression model demonstrated that for each unit increment in the AIP, the prediabetes and diabetes prevalence increased 4.96-fold among female participants (OR 4.96, 95% CI 2.68, 9.18) but not among male participants. We found that the AIP was not related to the prevalence of prediabetes or diabetes (OR 1.41; 95% CI 0.87, 2.29) among males. There was an interaction between sex and the AIP (P for interaction < 0.0001).

CONCLUSIONS

This study showed that a higher AIP was significantly associated with an increased prevalence of prediabetes and diabetes, and the above relationships occurred only among women and not men.

Liver Assessment in Patients with Ataxia-Telangiectasia: Transient Elastography Detects Early Stages of Steatosis and Fibrosis

Background

Ataxia-telangiectasia (A-T) is a rare autosomal-recessive multisystem disorder characterized by pronounced cerebellar ataxia, telangiectasia, cancer predisposition, and altered body composition. Liver diseases with steatosis, fibrosis, and hepatocellular carcinoma are frequent findings in older patients but sensitive noninvasive diagnostic tools are lacking.

Objectives

To determine the sensitivity of transient elastography (TE) as a screening tool for early hepatic tissue changes and serum biomarkers for liver disease.

Methods

Thirty-one A-T patients aged 2 to 25 years were examined prospectively from 2016-2018 by TE. In addition, we evaluated the diagnostic performance of liver biomarkers for steatosis and necroinflammatory activity (SteatoTest and ActiTest, Biopredictive, Paris) compared to TE. For calculation and comparison, patients were divided into two groups (<12, >12 years of age).

Results

TE revealed steatosis in 2/21 (10%) younger patients compared to 9/10 (90%) older patients. Fibrosis was present in 3/10 (30%) older patients as assessed by TE. We found a significant correlation of steatosis with SteatoTest, alpha-fetoprotein (AFP), HbA1c, and triglycerides. Liver stiffness correlated significantly with SteatoTest, ActiTest, HbA1c, and triglycerides.

Conclusion

Liver disease is a common finding in older A-T patients. TE is an objective measure to detect early stages of steatosis and fibrosis. SteatoTest and ActiTest are a good diagnostic assessment for steatosis and necroinflammatory activity in patients with A-T and confirmed the TE results.

Is a PCSK9 Inhibitor Right for Your Patient? A Review of Treatment Data for Individualized Therapy

INTRODUCTION

In the United States, a significant amount of the population is affected by hyperlipidemia, which is associated with increased levels of serum low-density lipoprotein (LDL-C) and risk of cardiovascular disease. As of 2019, the guidelines set by the American College of Cardiology/American Heart Association advocate for the use of statins as the major contributor to lowering serum LDL-C. While proven to be effective, side effects, including muscle-related symptoms and new-onset diabetes mellitus, can make patients unable to tolerate statin therapy. Additionally, there is a subset of the population which does not approach a recommended LDL-C goal on statin treatment. Due to these findings, it was deemed necessary to review the literature of current statin-alternative lipid-lowering therapies.

METHODS

A systematic review of preclinical and clinical papers, and a current meta-analysis, was performed using PubMed and Google Scholar. Following the literature review, a meta-analysis was conducted using ProMeta 3.

RESULTS

Through systematic review and meta-analysis of the current literature, it is suggested that newer lipid-lowering therapies such as proprotein convertase subtilsin-kixen type 9 (PCSK9) inhibitors are a safe and effective statin alternative for the population with statin intolerance. PCSK9 inhibitors were shown to have no significant effect in causing myalgia in patients and showed no increase in adverse cardiovascular outcomes compared to a control of a current antilipemic medication regimen.

DISCUSSION

There are many statin-alternative therapies that should be investigated further as a potential replacement for patients with statin intolerance or as an addition for patients with statin resistance.

Metabolic Syndrome and Cardiometabolic Risk Factors in the Mixed Hypercholesterolemic Populations with Respect to Gender, Age, and Obesity in Asir, Saudi Arabia

This record study aimed to investigate the prevalence of metabolic syndrome (MetS) profiles regarding sex, age, and obesity for the riskier factor of cardiovascular diseases in a general population in Saudi Arabia. Laboratory and anthropometric measurements were performed on non-specific participants with variant ages and BMI in either sex. Serobiochemical changes were measured for metabolic profiles, i.e., A1C/FSG, TC, TGC, HDLC/LDLC, Vit.D, TSH/T4, Hb, and Cr. The study was applied in a Polyclinic, Abha, Saudi Arabia in 2020 G. The general population showed variable incidences of MetS profiles, such as 69.4% diabetes, 85.5% hypothyroidism, and 92.2% obesity. Hypothyroidism showed a higher incidence in women rather than in men, but men were more dyslipidemic, with higher TGC and LDLC but low HDLC, compared to women. Men <40 Y. showed diabetes and hypothyroidism, but elders were dyslipidemic. Women <40 Y. showed anemia and hypovitaminosis-D but were suffering from hypothyroidism at all ages. Diabetes, hypothyroidism, hypovitaminosis-D, and dyslipidemia were the main MetS components in both overweight and obese participants, and an incidence of more than 50% in each profile was recorded. Diabetes with hypertension was characteristic of obese participants rather than those overweight. About 66.1% of the mixed-hypercholesterolemic cases were diabetic, but 18.9% of the mixed-diabetic participants were hypercholesterolemic. Castelli's risk factors, CRI-I and CRI-II, and atherogenic indices, AIP and AC, were measured for evaluating the cardiac risk in different populations based on the AUC-ROC and cut-off values. Insulin-resistance marker (TyG) was also measured, showing considerable cut-off values for diabetic susceptibility in the lipidemic participants with higher TGC and TC rather than HDLC or LDLC. In conclusion, MetS showed higher susceptibility to sex and age with increased incidence in women rather than men. However, the cardiac risk was more susceptible to men of higher TGC and low HDLC than women. Type 2 Diabetes mellitus (T2DM) was more prominent in both elders (≥40 Y.) than younger ages of either sex. Anemia and deficiency of Vit. D was characteristic of young women (<40 Y.). Hypothyroidism affects young men <40 Y. but was recorded in women of all ages. Both dyslipidemia and diabetes could trigger CVD, showing higher cardiac risk in mixed-hypercholesterolemic men rather than women. Our study strongly suggests that the consumption of unhealthy junk food, tobacco smoking, lack of exercise, and physical inactivity could be conclusive evidence of MetS in the Saudi population.

Potential Mediators of Causal Associations of Circulating Triglycerides With Blood Pressure: Evidence From Genetic and Observational Data

Background:

Existing evidence indicates that elevated triglycerides may affect blood pressure, but the underlying mechanisms are not fully understood. Herein, we aim to identify the intermediaries of associations of triglyceride with systolic blood pressure and diastolic blood pressure using the Mendelian randomization (MR) framework.

Methods:

Triglyceride-associated single nucleotide polymorphisms were extracted and used to match phenotypes in PhenoScanner. From the broad spectrum of possible triglyceride-associated traits, potential mediators linking triglyceride to blood pressure were screened out by MR and MR-based mediation analysis. Moreover, cross-sectional observational data of 206 341 adults were used to validate the mediators identified at the genetic level.

Results:

Among the nearly 100 raw phenotypes matched by 313 triglyceride-associated single nucleotide polymorphisms, 39 traits were filtered and integrated into subsequent analysis. By further filtering using MR analysis, only pulse rate and lymphocyte count (LC) were identified as independent mediators. MR-based mediation analysis showed that genetically predicted LC could mediate 9.2% of the association of triglyceride with systolic blood pressure; genetically predicted pulse rate and LC could mediate 18.3% and 17.6% of the association of triglyceride with DBP, respectively. Observational data also support the mediating role of pulse rate and LC.

Conclusions:

The current findings highlighted the mediating role of pulse rate and LC on the causal pathway from triglyceride to blood pressure and may contribute to a better understanding of the pathogenic mechanism by which high triglyceride affects other cardiometabolic factors.

Effects of Gestational Diabetes Mellitus on Cholesterol Metabolism in Women with High-Risk Pregnancies: Possible Implications for Neonatal Outcome

Metabolic disorders in pregnancy, particularly gestational diabetes mellitus (GDM), are associated with an increased risk for adverse pregnancy outcome and long-term cardiometabolic health of mother and child. This study analyzed changes of serum cholesterol synthesis and absorption markers during the course of high-risk pregnancies, with respect to the development of GDM. Possible associations of maternal lipid biomarkers with neonatal characteristics were also investigated. The study included 63 women with high risk for development of pregnancy complications. Size and proportions of small low-density (LDL) and high-density lipoprotein (HDL) particles were assessed across trimesters (T1−T3), as well as concentrations of cholesterol synthesis (lathosterol, desmosterol) and absorption markers (campesterol, β-sitosterol). During the study, 15 women developed GDM, while 48 had no complications (non-GDM). As compared to the non-GDM group, women with GDM had significantly higher triglycerides in each trimester, while having a lower HDL-C level in T3. In addition, they had significantly lower levels of β-sitosterol in T3 (p < 0.05). Cholesterol synthesis markers increased across trimesters in both groups. A decrease in serum β-sitosterol levels during the course of pregnancies affected by GDM was observed. The prevalence of small-sized HDL decreased in non-GDM, while in the GDM group remained unchanged across trimesters. Newborn’s size in the non-GDM group was significantly higher (p < 0.01) and inversely associated with proportions of both small, dense LDL and HDL particles (p < 0.05) in maternal plasma in T1. In conclusion, high-risk pregnancies affected by GDM are characterized by altered cholesterol absorption and HDL maturation. Advanced lipid testing may indicate disturbed lipid homeostasis in GDM.

Causal Graph Among Serum Lipids and Glycemic Traits: A Mendelian Randomization Study

We systematically investigated the bidirectional causality among HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglycerides (TGs), fasting insulin (FI), and glycated hemoglobin A1c (HbA1c) based on genome-wide association summary statistics of Europeans (n = 1,320,016 for lipids, 151,013 for FI, and 344,182 for HbA1c). We applied multivariable Mendelian randomization (MR) to account for the correlation among different traits and constructed a causal graph with 13 significant causal effects after adjusting for multiple testing (P < 0.0025). Remarkably, we found that the effects of lipids on glycemic traits were through FI from TGs (β = 0.06 [95% CI 0.03, 0.08] in units of 1 SD for each trait) and HDL-C (β = -0.02 [-0.03, -0.01]). On the other hand, FI had a strong negative effect on HDL-C (β = -0.15 [-0.21, -0.09]) and positive effects on TGs (β = 0.22 [0.14, 0.31]) and HbA1c (β = 0.15 [0.12, 0.19]), while HbA1c could raise LDL-C (β = 0.06 [0.03, 0.08]) and TGs (β = 0.08 [0.06, 0.10]). These estimates derived from inverse-variance weighting were robust when using different MR methods. Our results suggest that elevated FI was a strong causal factor of high TGs and low HDL-C, which in turn would further increase FI. Therefore, early control of insulin resistance is critical to reduce the risk of type 2 diabetes, dyslipidemia, and cardiovascular complications.

The Effects of Chitosan-PEG Nanoparticles Based on Channa striata Protein Hydrolyzate on Decreasing Diabetes Mellitus in Diabetic Rats

Background

Channa striata has several good nutrients, including 70% protein, 20% albumin, complete amino acids, zinc, selenium, and iron. However, no study has investigated the chitosan-PEG nanoparticles based on Channa striata protein hydrolyzate. This study's purpose was to determine the role of 10% Channa striata protein hydrolyzate, chitosan-PEG 4000 nanoparticles, and chitosan-PEG 6000 nanoparticles in reducing diabetes mellitus in diabetic rats.

Method

A randomized pretest-posttest control group design was used, with male Sprague-Dawley rats being divided into five groups: STZ, acarbose, hydrolyzate, chitosan-PEG 4000 nanoparticles, and chitosan-PEG 6000 nanoparticles. Diabetes was induced by a single injection of streptozotocin at 1 ml in each formulation. Blood glucose levels were analyzed using a glucometer 7, 14, and 21 days after treatment. The CHOD-PAP method was used to analyze the lipid profile. Pancreas and liver histology analyses were carried out using a microscope.

Results

The formulation of 10% Channa striata protein hydrolyzate and PEG 6000 was the most effective in lowering blood glucose concentrations, and the response was close to the acarbose result. The glucose concentration decreased after daily oral administration of chitosan-PEG nanoparticles for 21 days. The plasma cholesterol, triglycerides, LDL, and HDL concentrations were lower in treated than in untreated diabetic rats.

Conclusion

This study concluded that the formulation of 10% Channa striata protein hydrolyzate and chitosan-PEG 6000 nanoparticles was more effective than acarbose.

Morbid Obesity in Women Is Associated with an Altered Intestinal Expression of Genes Related to Cancer Risk and Immune, Defensive, and Antimicrobial Response

Background: Little is known about the relation between morbid obesity and duodenal transcriptomic changes. We aimed to identify intestinal genes that may be associated with the development of obesity regardless of the degree of insulin resistance (IR) of patients. Material and Methods: Duodenal samples were assessed by microarray in three groups of women: non-obese women and women with morbid obesity with low and high IR. Results: We identified differentially expressed genes (DEGs) associated with morbid obesity, regardless of IR degree, related to digestion and lipid metabolism, defense response and inflammatory processes, maintenance of the gastrointestinal epithelium, wound healing and homeostasis, and the development of gastrointestinal cancer. However, other DEGs depended on the IR degree. We mainly found an upregulation of genes involved in the response to external organisms, hypoxia, and wound healing functions in women with morbid obesity and low IR. Conclusions: Regardless of the degree of IR, morbid obesity is associated with an altered expression of genes related to intestinal defenses, antimicrobial and immune responses, and gastrointestinal cancer. Our data also suggest a deficient duodenal immune and antimicrobial response in women with high IR.

HDL functionality in type 1 and type 2 diabetes: new insights

PURPOSE OF REVIEW

To critically appraise new insights into HDL structure and function in type 1 diabetes (T1DM) and type 2 diabetes (T2DM).

RECENT FINDINGS

In young T1DM patients with early renal impairment and a high inflammatory score, both HDL antioxidative activity and endothelial vasodilatory function were impaired, revealing a critical link between HDL dysfunction, subclinical vascular damage, systemic inflammation and end organ damage. HDL may inhibit development of T2DM by attenuating endoplasmic reticulum (ER) stress and apoptotic loss of pancreatic β-cells, an effect due in part to ABC transporter-mediated efflux of specific oxysterols with downstream activation of the hedghehog signalling receptor, Smoothened. The apoM-sphingosine-1-phosphate complex is critical to HDL antidiabetic activity, encompassing protection against insulin resistance, promotion of insulin secretion, enhanced β-cell survival and inhibition of hepatic glucose production. Structure-function studies of HDL in hyperglycemic, dyslipidemic T2DM patients revealed both gain and loss of lipidomic and proteomic components. Such changes attenuated both the optimal protective effects of HDL on mitochondrial function and its capacity to inhibit endothelial cell apoptosis. Distinct structural components associated with individual HDL functions.

SUMMARY

Extensive evidence indicates that both the proteome and lipidome of HDL are altered in T1DM and T2DM, with impairment of multiple functions.

The Association and Mediating Biomarkers of Serum Retinol in Influencing the Development of Type 2 Diabetes: A Prospective Cohort Study in Middle-Aged and Elderly Population

The aims of this research are to elucidate whether serum retinol is associated with type 2 diabetes and to explore the underlying mechanisms of the association in a prospective cohort study. A total of 3,526 diabetes-free participants aged 40 years or older were enrolled at baseline in 2010–2012. Multivariable logistic regression was adopted to evaluate the associations of serum retinol and dietary vitamin A (VA) intake with type 2 diabetes. Mediation analyses were used to reveal potential mediators in their associations. After a mean follow-up of 5.3 years, 280 incident cases of type 2 diabetes occurred. Serum retinol was positively associated with the incidence of type 2 diabetes. The multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for type 2 diabetes from the bottom to the top quintile of serum retinol were 1, 1.878 (1.202, 2.936), 2.110 (1.364, 3.263), 1.614 (1.027, 2.538), and 2.134 (1.377, 3.306) (p-trend = 0.009), respectively. Mediation analysis showed that increased homeostasis model assessment - insulin resistance HOMA-IR, triglycerides (TG), and serum xanthine oxidase (XO) activity could account for 8.5, 14.7, and 12.1% of the total effects of serum retinol on type 2 diabetes, respectively. Serum retinol concentration was not significantly associated with dietary VA intake (r = −0.010, p = 0.570). In addition, no significant relationship was observed between dietary VA intake and the risk of type 2 diabetes. Overall, elevated serum retinol might increase the risk of type 2 diabetes which is mainly mediated by increased insulin resistance, TG, or serum XO activity.

The longitudinal effect of the atherogenic index of plasma on type 2 diabetes in middle-aged and older Chinese

AIMS

Atherogenic Index of Plasma (AIP) has been proposed as a novel marker of plasma atherogenicity, but its longitudinal predictive value in type 2 diabetes mellitus (T2DM) remains unclear. We aimed to assess the associations of AIP and its longitudinal transition with T2DM among middle-aged and older Chinese.

METHODS

Data were extracted from four rounds of the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018). AIP was calculated as log₁₀ (triglyceride/high-density lipoprotein cholesterol). Participants were classified into high and low AIP groups at baseline, and subsequently into four transition patterns during follow-up: maintained-high, maintained-low, high-to-low, and low-to-high AIP. Multivariable Cox frailty models were applied to explore the longitudinal transition patterns of AIP on the development of T2DM.

RESULTS

A total of 8760 subjects without T2DM were selected in 2011, of which 981 developed T2DM until 2018. When compared with people with maintained-low AIP patterns, those with transition patterns of maintained-high AIP, high-to-low AIP, and low-to-high AIP were at around 1.5 times higher risk of T2DM (HR_adj = 1.69, 1.32, and 1.47, respectively, all P < 0.05). However, the risk of T2DM did not decrease in the high-to-low AIP group as compared to the maintained-high AIP group.

CONCLUSIONS

Three longitudinal AIP transition patterns (maintained-high AIP, high-to-low AIP, and low-to-high AIP) were associated with the development of T2DM. Preventions are needed to combat T2DM at an early dyslipidemic stage.

Sorghum halepense (L.) Pers rhizomes inhibitory potential against diabetes and free radicals

Background

Owing to the side effects of synthetic medicine and less effectiveness against different syndromes, the researchers have focused on phytotherapy to overcome these problems. The purpose of this project was to study the in vitro phytochemical, cytotoxic, total phenolic, antioxidant and antidiabetic activities of the methanol extract of the rhizome of Sorghum halepense (L.) Pers and its n-hexane, chloroform and aqueous fractions. Thereafter, to conduct in vivo evaluation of the effective extract for its antidiabetic and antioxidant characteristics.

Methods

Cytotoxic, total phenolic content and antidiabetic properties were ascertained by brine shrimps lethality, Folin- Ciocalteu reagent and alpha-amylase inhibition assays respectively while antioxidant activities were investigated through DPPH, ABTS and H2O2 assays. The methanolic extract was assessed in vivo for its antidiabetic and antioxidant activities by using Wistar albino rats.

Results

The phytochemical investigation of the methanolic extract and its unlike fractions revealed the availability of alkaloids, cardiac glycosides, flavonoids, terpenes, steroids, carbohydrate and proteins while lack of saponins and gums in methanolic extract. Steroids and carbohydrates were only present in aqueous and chloroform fraction respectively while both fractions contained proteins and alkaloids. Cardiac glycosides and flavonoids were absent in aqueous and chloroform fractions respectively. The highest brine shrimps lethality (70.5 ± 1.2), total phenolic content (28.30 ± 1.3 mg GAE/g), free radicals scavenging potential i.e. DPPH (40.02%), ABTS (40.48%) and H2O2 (50.85%) and alpha amylase inhibition (61.87%) was shown by the methanolic extract. The in vivo results did not disclose any sign of acute toxicity. The diabetic control showed a noteworthy (P < 0.05) decline in weight, HDL and glutathione and a raised level of bilirubin, blood glucose, urea, creatinine, triglyceride, LDL, VLDL, ALT, ALP, AST, SOD, catalase. The mentioned alterations were restored considerably (P < 0.05) by treatment of diabetic rats with methanolic extract of Sorghum halepense (L.) Pers (150 and 300 mg/kg b.w.).

Conclusion

It is concluded that the extract of rhizomes of Sorghum halepense (L.) Pers is an effective fount of antioxidant and anti-diabetic compounds. Further analysis is needed to sharpen its pharmacological activities.

Associations of Body Mass Index and Waist Circumference in Young Adulthood with Later Life Incident Diabetes

CONTEXT

The independent contribution of young adult exposure to overweight and obesity to later-life incident diabetes is not well studied.

OBJECTIVE

To assess the associations of exposures to elevated body mass index (BMI) and waist circumference (WC) in young adulthood (ages 18-39 years) with incident diabetes later in life (≥40 years).

DESIGN

Pooled data from 6 US prospective cohorts (Atherosclerosis Risk in Communities Study, Cardiovascular Risk Development in Young Adults Study, Cardiovascular Health Study, (4) Framingham Heart Study Offspring Cohort, (5) Health, Aging and Body Composition Study, and (6) Multi-Ethnic Study of Atherosclerosis.

SETTING

Population-based cohort studies.

PARTICIPANTS

30 780 participants (56.1% female, 69.8% non-Hispanic white) without a diagnosis of diabetes by age 40.

INTERVENTIONS

We imputed BMI and WC trajectories from age 18 for every participant and estimated time-weighted average exposures to BMI or WC during young adulthood and later life.

MAIN OUTCOME MEASURE(S)

Incident diabetes defined as fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, or use of diabetes medications.

RESULTS

During a 9-year median follow-up, 4323 participants developed incident diabetes. Young adult BMI and WC were associated with later-life incident diabetes after controlling for later-life exposures [hazard ratios (HR) 1.99 for BMI ≥ 30 kg/m2 and 2.13 for WC > 88cm (women)/>102cm (men) compared to normal ranges]. Young adult homeostatic model of insulin resistance mediated 49% and 44% of the association between BMI and WC with later-life incident diabetes. High-density lipoproteins and triglycerides mediated a smaller proportion of these associations.

CONCLUSIONS

Elevated BMI and WC during young adulthood were independently associated with later-life incident diabetes. Insulin resistance may be a key mediator.

A sex-related mediating effect of uric acid in the association between body composition and blood pressure in children and adolescents

The increase in blood pressure (BP) during somatic growth might have direct determinants but also mediating factors. We investigated whether uric acid (UA) and other metabolic factors would mediate the association between body composition components and BP. A cross-sectional study was conducted in 928 children and adolescents (aged 6-18 years), in which body composition and blood biochemistry were evaluated. Structural equation modeling was performed to test the direct and indirect pathways between systolic blood pressure (SBP) and body composition parameters. Muscle mass (MM) showed a strong direct effect on BP, regardless of sex. In girls, a mediating pathway through UA was not significant, but the association between fat mass (FM) and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA, but not via the cluster of metabolic factors. The association between body composition and BP in children and adolescents has a complex design and also has a sex-specific mediating component. The increase in the UA levels may affect BP levels early in boys. Also, metabolic changes elicited by FM contribute to the increase in BP at an early age in girls. Novelty: MM showed a strong direct effect on BP, regardless of sex. In girls, the association between FM and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA.

Positive association between the ratio of triglycerides to high-density lipoprotein cholesterol and diabetes incidence in Korean adults

BACKGROUND

Insulin resistance is associated with the incidence of diabetes and cardiovascular diseases such as myocardial infarction. The ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) (TG/HDL-C ratio) is positively correlated with insulin resistance. This study aimed to investigate the relationship between the TG/HDL-C ratio and the incidence of diabetes in Korean adults.

METHODS

This retrospective study used data from the National Health Insurance Service-National Health Screening Cohort. The TG/HDL-C ratio was divided into three tertiles, the T₁, T₂, and T₃ groups, based on sex. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for diabetes using multivariate Cox proportional hazards regression analyses.

RESULTS

A total of 80,693 subjects aged between 40 and 79 years were enrolled. The median follow-up period was 5.9 years. The estimated cumulative incidence of diabetes in the T₁, T₂, and T₃ groups was 5.94%, 8.23%, and 13.50%, respectively, in men and 4.12%, 4.72%, and 6.85%, respectively, in women. Compared to T₁, the fully adjusted HRs (95% CIs) of the T₂ and T₃ groups for new-onset diabetes were 1.17 (1.06-1.30) and 1.47 (1.34-1.62), respectively, in men and 1.20 (1.02-1.42) and 1.52 (1.30-1.78), respectively, in women.

CONCLUSIONS

Increased TG/HDL-C ratio was significantly associated with a higher risk of new-onset diabetes in both sexes.

The influence of high-density lipoprotein (HDL) and HDL subfractions on insulin secretion and cholesterol efflux in pancreatic derived β-cells

BACKGROUND

High-density lipoprotein (HDL) is considered a complex plasma-circulating particle with subfractions that vary in function, size, and chemical composition. We sought to test the effects of HDL, and HDL subfractions on insulin secretion and cholesterol efflux in the β-cell line MIN-6.

METHODS

We used total HDL and HDL subfractions 2a, 2b, 3a, 3b, and 3c, isolated from human plasma, to test insulin secretion under different glucose concentrations as well as insulin content and cholesterol efflux in the insulinoma MIN-6 cell line.

RESULTS

Incubation of MIN-6 cells with low glucose and total HDL increased insulin release two-fold. Meanwhile, when high glucose and HDL were used, insulin release increased more than five times. HDL subfractions 2a, 2b, 3a, 3b, and 3c elicited higher insulin secretion and cholesterol efflux than their respective controls, at both low and high glucose concentrations. The insulin content of the MIN-6 cells incubated with low glucose and any of the five HDL subclasses had a modest reduction compared with their controls. However, there were no statistically significant differences between each HDL subfraction on their capacity of eliciting insulin secretion, insulin content, or cholesterol efflux.

CONCLUSIONS

HDL can trigger insulin secretion under low, normal, and high glucose conditions. We found that all HDL subfractions exhibit very similar capacity to increase insulin secretion and cholesterol efflux. This is the first report demonstrating that HDL subfractions act both as insulin secretagogues (under low glucose) and insulin secretion enhancers (under high glucose) in the MIN-6 cell line.

Pre-Metabolic Syndrome and Incidence of Type 2 Diabetes and Hypertension: From the Korean Genome and Epidemiology Study

The aim of this study was to investigate the prevalence of premetabolic syndrome (pre-MetSyn) and its components and to longitudinally examine their association with new-onset type 2 diabetes (T2D) or hypertension. A total of 4037 men and 4400 women aged 40 to 69 years were selected from the Korean Genome and Epidemiology Study, observed from 2001 to 2014. Pre-MetSyn was defined as the presence of one or two components of MetSyn (B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; T, elevated triglycerides; W, increased waist circumference). The prevalence of pre-MetSyn was higher than that of non-MetSyn and MetSyn in both men and women. In multivariate Cox regression analyses, G, T, G+T, W+G, B+G, B+T, W+T, B+H, and H+T in men and G, T, G+H, B+T, and H+T in women were significantly associated with new-onset T2D. B, W, B+H, B+T, W+H, and W+T in men and B, B+T, B+H, B+W, and W+H in women were significantly associated with new-onset hypertension. The prevalence of pre-MetSyn components and their associations with new-onset T2D or hypertension differed according to sex and disease. Our results suggest that specific phenotypes of pre-MetSyn may be important factors for predicting and preventing the development of T2D and hypertension.

Effect of hydroxychloroquine on lipid levels: A systematic review and meta-analysis

BACKGROUND

It has been suggested that hydroxychloroquine may have positive effects on LDL-C, HDL-C, and triglyceride levels; however, the hypolipidemic activities of this drug are still uncertain.

OBJECTIVE

The aim of this meta-analysis of randomized controlled trials was to explore the effect of hydroxychloroquine on circulating lipid concentrations.

METHOD

Randomized controlled trials examining the impact of hydroxychloroquine on lipid parameters were searched in PubMed, Web of Science, Scopus, and Google Scholar databases. Meta-analysis was performed using a random-effects model and sensitivity analysis through the leave one-out method.

RESULTS

Meta-analysis showed that patients receiving hydroxychloroquine therapy significantly decreased total cholesterol (WMD: 0.18 mmol/L, 95% CI: -0.28, -0.08, I2 = 6%, p = 0.0004), LDL-C (WMD: -0.21 mmol/L, 95% CI: -0.36, -0.06, I2 = 75%, p = 0.006), triglycerides (WMD: -0.09 mmol/L, 95% CI: -0.15, -0.04, I2 = 22%, p = 0.001), and non-HDL-C (WMD: -0.28 mmol/L, 95% CI: -0.45, -0.12, I2 = 0%, p = 0.0009), and increased HDL-C concentrations (WMD: 0.03 mmol/L, 95% CI: 0.00, 0.06, I2 = 0%, p = 0.03).

CONCLUSION

Our results suggest that hydroxychloroquine improves lipid parameters by reducing total cholesterol, LDL-C, triglycerides, non-HDL-C, and increasing HDL-C levels.

Atherogenic index of plasma as predictors for metabolic syndrome, hypertension and diabetes mellitus in Taiwan citizens: a 9-year longitudinal study

Deeply involved with dyslipidemia, cardiovascular disease has becoming the leading cause of mortality since the early twentieth century in the modern world. Whose correlation with metabolic syndrome (MetS), hypertension and type 2 diabetes mellitus (T2DM) has been well established. We conducted a 9-year longitudinal study to identify the association between easily measured lipid parameters, future MetS, hypertension and T2DM by gender and age distribution. Divided into three groups by age (young age: < 40, middle age: ≥ 40 and < 65 and old age: ≥ 65), 7670 participants, receiving standard medical inspection at Tri-Service General Hospital (TSGH) in Taiwan, had been enrolled in this study. Atherogenic index of plasma (AIP) was a logarithmically transformed ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C). Through multivariate regression analyses, the hazard ratio (HR) of AIP for MetS, hypertension and T2DM were illustrated. AIP revealed significant association with all the aforementioned diseases through the entire three models for both genders. Additionally, AIP revealed significant correlation which remained still after fully adjustment in MetS, hypertension, and T2DM groups for subjects aged 40–64-year-old. Nevertheless, for participants aged above 65-year-old, AIP only demonstrated significant association in MetS group. Our results explore the promising value of AIP to determine the high-risk subjects, especially meddle-aged ones, having MetS, hypertension, and T2DM in the present and the future.

HDL Cholesterol and Non-Cardiovascular Disease: A Narrative Review

High density lipoprotein (HDL) cholesterol has traditionally been considered the “good cholesterol”, and most of the research regarding HDL cholesterol has for decades revolved around the possible role of HDL in atherosclerosis and its therapeutic potential within atherosclerotic cardiovascular disease. Randomized trials aiming at increasing HDL cholesterol have, however, failed and left questions to what role HDL cholesterol plays in human health and disease. Recent observational studies involving non-cardiovascular diseases have shown that high levels of HDL cholesterol are not necessarily associated with beneficial outcomes as observed for age-related macular degeneration, type II diabetes, dementia, infection, and mortality. In this narrative review, we discuss these interesting associations between HDL cholesterol and non-cardiovascular diseases, covering observational studies, human genetics, and plausible mechanisms.