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Millar SR, Harrington JM, Perry IJ, Phillips CM. Ultra-processed food and drink consumption and lipoprotein subclass profiles: A cross-sectional study of a middle-to older-aged population. Clin Nutr 2024; 43:1972-1980. [PMID: 39033562 DOI: 10.1016/j.clnu.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/30/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND AIMS Studies have consistently demonstrated associations between ultra-processed food and drink (UPFD) consumption and non-communicable diseases. However, there is a lack of data investigating relationships between UPFD intake and intermediate cardiometabolic disease markers. In this study we explored UPFD associations with lipoprotein subclasses. METHODS This was a cross-sectional study of 1986 middle-to older-aged men and women randomly selected from a large primary care centre. The percentage contribution of UPFDs to total energy intake was calculated for each participant using the NOVA classification. Lipoprotein particle subclass concentrations and size were determined using nuclear magnetic resonance spectroscopy. Correlation and multivariate-adjusted linear regression analyses were performed to examine UPFD intake relationships with lipoprotein subclasses. RESULTS In fully adjusted regression models, higher UPFD consumption was associated with reduced high-density lipoprotein (HDL) cholesterol concentrations (β = -0.024, p = 0.001), large low-density lipoprotein (LDL) levels (β = -18.645, p = 0.002), total and medium HDL concentrations (β = -0.328, p = 0.012; β = -0.510, p < 0.001), smaller LDL and HDL size (β = -0.026, p = 0.023; β = -0.023, p = 0.024), and increased medium very low-density lipoprotein levels (β = 0.053, p = 0.022), small LDL and HDL concentrations (β = 20.358, p = 0.02; β = 0.336, p = 0.011), and higher lipoprotein insulin resistance scores (β = 0.048, p = 0.012), reflecting greater lipoprotein-related insulin resistance. CONCLUSIONS Findings from this research suggest that increased intake of UPFDs is associated with a more pro-atherogenic, insulin-resistant metabolic profile in middle-to older-aged adults which may be a potential mechanism underlying reported associations between UPFD consumption and chronic disease risk and mortality.
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Affiliation(s)
- Seán R Millar
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland.
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Millar SR, Navarro P, Harrington JM, Perry IJ, Phillips CM. The Nutri-Score nutrition label: Associations between the underlying nutritional profile of foods and lipoprotein particle subclass profiles in adults. Atherosclerosis 2024; 395:117559. [PMID: 38692976 DOI: 10.1016/j.atherosclerosis.2024.117559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND AIMS Lipoprotein particle concentrations and size are associated with increased risk for atherosclerosis and premature cardiovascular disease. Certain dietary behaviours may be cardioprotective and public health strategies are needed to guide consumers' dietary choices and help prevent diet-related disease. The Food Standards Agency nutrient profiling system (FSAm-NPS) constitutes the basis of the five-colour front-of-pack Nutri-Score labelling system. No study has examined FSAm-NPS index associations with a wide range of lipoprotein particle subclasses. METHODS This was a cross-sectional study of 2006 middle-to older-aged men and women randomly selected from a large primary care centre. Individual participant FSAm-NPS dietary scores were derived from validated food frequency questionnaires. Lipoprotein particle subclass concentrations and size were determined using nuclear magnetic resonance spectroscopy. Multivariate-adjusted linear regression analyses were performed to examine FSAm-NPS relationships with lipoprotein particle subclasses. RESULTS In fully adjusted models which accounted for multiple testing, higher FSAm-NPS scores, indicating poorer dietary quality, were positively associated with intermediate-density lipoprotein (β = 0.096, p = 0.005) and small high-density lipoprotein (HDL) (β = 0.492, p = 0.006) concentrations, a lipoprotein insulin resistance score (β = 0.063, p = 0.02), reflecting greater lipoprotein-related insulin resistance, and inversely associated with HDL size (β = -0.030, p = 0.045). CONCLUSIONS A higher FSAm-NPS score is associated with a less favourable lipoprotein particle subclass profile in middle-to older-aged adults which may be a potential mechanism underlying reported health benefits of a healthy diet according to Nutri-Score rating.
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Affiliation(s)
- Seán R Millar
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland.
| | - Pilar Navarro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, 4, Ireland
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, 4, Ireland
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3
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Turecamo S, Downie CG, Wolska A, Mora S, Otvos JD, Connelly MA, Remaley AT, Conners KM, Joo J, Sampson M, Bielinski SJ, Shearer JJ, Roger VL. Lipoprotein Insulin Resistance Score and Mortality Risk Stratification in Heart Failure. Am J Med 2024; 137:640-648. [PMID: 38583752 PMCID: PMC11213682 DOI: 10.1016/j.amjmed.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Higher total serum cholesterol is associated with lower mortality in heart failure. Evaluating associations between lipoprotein subfractions and mortality among people with heart failure may provide insights into this observation. METHODS We prospectively enrolled a community cohort of people with heart failure from 2003 to 2012 and assessed vital status through 2021. Plasma collected at enrollment was used to measure lipoprotein subfractions via nuclear magnetic resonance spectroscopy. A composite score of 6 lipoprotein subfractions was generated using the lipoprotein insulin resistance index (LP-IR) algorithm. Using covariate-adjusted proportional hazards regression models, we evaluated associations between LP-IR score and all-cause mortality. RESULTS Among 1382 patients with heart failure (median follow-up 13.9 years), a one-standard-deviation (SD) increment in LP-IR score was associated with lower mortality (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.97-0.99). Among LP-IR parameters, mean high-density lipoprotein (HDL) particle size was significantly associated with lower mortality (HR per 1-SD decrement in mean HDL particle size = 0.83; 95% CI, 0.78-0.89), suggesting that the inverse association between LP-IR score and mortality may be driven by smaller mean HDL particle size. CONCLUSIONS LP-IR score was inversely associated with mortality among patients with heart failure and may be driven by smaller HDL particle size.
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Affiliation(s)
- Sarah Turecamo
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Carolina G Downie
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Anna Wolska
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - James D Otvos
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Katherine M Conners
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jungnam Joo
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Maureen Sampson
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Suzette J Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Joseph J Shearer
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Véronique L Roger
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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Dugani SB, Moorthy MV, Demler OV, Li C, Ridker PM, Glynn RJ, Mora S. Plasma Biomarker Profiles for Premature and Nonpremature Coronary Heart Disease in Women. Clin Chem 2024; 70:768-779. [PMID: 38472127 PMCID: PMC11062763 DOI: 10.1093/clinchem/hvae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/18/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND Premature coronary heart disease (CHD) is a major cause of death in women. We aimed to characterize biomarker profiles of women who developed CHD before and after age 65 years. METHODS In the Women's Health Study (median follow-up 21.5 years), women were grouped by age and timing of incident CHD: baseline age <65 years with premature CHD by age 65 years (25 042 women; 447 events) and baseline age ≥65 years with nonpremature CHD (2982 women; 351 events). Associations of 44 baseline plasma biomarkers measured using standard assays and a nuclear magnetic resonance (NMR)-metabolomics assay were analyzed using Cox models adjusted for clinical risk factors. RESULTS Twelve biomarkers showed associations only with premature CHD and included lipoprotein(a), which was associated with premature CHD [adjusted hazard ratio (HR) per SD: 1.29 (95% CI 1.17-1.42)] but not with nonpremature CHD [1.09(0.98-1.22)](Pinteraction = 0.02). NMR-measured lipoprotein insulin resistance was associated with the highest risk of premature CHD [1.92 (1.52-2.42)] but was not associated with nonpremature CHD (Pinteraction <0.001). Eleven biomarkers showed stronger associations with premature vs nonpremature CHD, including apolipoprotein B. Nine NMR biomarkers showed no association with premature or nonpremature CHD, whereas 12 biomarkers showed similar significant associations with premature and nonpremature CHD, respectively, including low-density lipoprotein (LDL) cholesterol [1.30(1.20-1.45) and 1.22(1.10-1.35)] and C-reactive protein [1.34(1.19-1.50) and 1.25(1.08-1.44)]. CONCLUSIONS In women, a profile of 12 biomarkers was selectively associated with premature CHD, driven by lipoprotein(a) and insulin-resistant atherogenic dyslipoproteinemia. This has implications for the development of biomarker panels to screen for premature CHD.
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Affiliation(s)
- Sagar B Dugani
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, United States
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - M Vinayaga Moorthy
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Olga V Demler
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Chunying Li
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Paul M Ridker
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert J Glynn
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Collins KA, Kraus WE, Rogers RJ, Hauser ER, Lang W, Jiang R, Schelbert EB, Huffman KM, Jakicic JM. Effect of behavioral weight-loss program on biomarkers of cardiometabolic disease risk: Heart Health Study randomized trial. Obesity (Silver Spring) 2023; 31:338-349. [PMID: 36621902 PMCID: PMC9877129 DOI: 10.1002/oby.23618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/11/2022] [Accepted: 09/27/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aimed to determine whether novel biomarkers of cardiometabolic health improve in response to a 12-month behavioral weight-loss intervention and to compare benefits of diet alone with diet plus physical activity for these biomarkers. METHODS Participants (N = 374) were randomized to either diet alone (DIET), diet plus 150 min/wk of prescribed moderate-intensity physical activity (DIET + PA150), or diet plus 250 min/wk of prescribed moderate-intensity physical activity (DIET + PA250). Biomarker concentrations were determined using nuclear magnetic resonance spectroscopy. Mixed models assessed for a time effect, group effect, or group by time interaction. RESULTS All groups significantly improved body weight (time: p < 0.0001), Lipoprotein Insulin Resistance Index score (time: p < 0.0001), Diabetes Risk Index score (time: p < 0.0001), branched-chain amino acid concentration (time: p < 0.0001), and GlycA concentration (time: p < 0.0001), with no group effect or group by time interactions. CONCLUSIONS All intervention groups prompted a notable beneficial change among biomarkers of insulin resistance and cardiometabolic health. However, the addition of at least moderate-intensity physical activity to a diet-only intervention did not provide any additional benefit. These findings highlight that an average weight loss of approximately 10% profoundly impacts biomarkers of insulin resistance and cardiometabolic disease in adults with overweight or obesity.
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Affiliation(s)
- Katherine A. Collins
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William E. Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Elizabeth R. Hauser
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina USA
| | - Wei Lang
- Center on Aging and Mobility, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erik B. Schelbert
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Minneapolis Heart Institute East, Saint Paul, Minnesota, USA
| | - Kim M. Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | - John M. Jakicic
- University of Kansas Medical Center, Department of Internal Medicine, Division of Physical Activity and Weight Management, Kansas City, Kansas, USA
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Rhodes CH, Zhu C, Agus J, Tang X, Li Q, Engebrecht J, Zivkovic AM. Human fasting modulates macrophage function and upregulates multiple bioactive metabolites that extend lifespan in Caenorhabditis elegans: a pilot clinical study. Am J Clin Nutr 2023; 117:286-297. [PMID: 36811567 PMCID: PMC10196604 DOI: 10.1016/j.ajcnut.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/28/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Periodic prolonged fasting (PF) extends lifespan in model organisms and ameliorates multiple disease states both clinically and experimentally owing, in part, to its ability to modulate the immune system. However, the relationship between metabolic factors, immunity, and longevity during PF remains poorly characterized especially in humans. OBJECTIVE This study aimed to observe the effects of PF in human subjects on the clinical and experimental markers of metabolic and immune health and uncover underlying plasma-borne factors that may be responsible for these effects. METHODS In this rigorously controlled pilot study (ClinicalTrial.gov identifier, NCT03487679), 20 young males and females participated in a 3-d study protocol including assessments of 4 distinct metabolic states: 1) overnight fasted baseline state, 2) 2-h postprandial fed state, 3) 36-h fasted state, and 4) final 2-h postprandial re-fed state 12 h after the 36-h fasting period. Clinical and experimental markers of immune and metabolic health were assessed for each state along with comprehensive metabolomic profiling of participant plasma. Bioactive metabolites identified to be upregulated in circulation after 36 h of fasting were then assessed for their ability to mimic the effects of fasting in isolated human macrophage as well as the ability to extend lifespan in Caenorhabditis elegans. RESULTS We showed that PF robustly altered the plasma metabolome and conferred beneficial immunomodulatory effects on human macrophages. We also identified 4 bioactive metabolites that were upregulated during PF (spermidine, 1-methylnicotinamide, palmitoylethanolamide, and oleoylethanolamide) that could replicate these immunomodulatory effects. Furthermore, we found that these metabolites and their combination significantly extended the median lifespan of C. elegans by as much as 96%. CONCLUSIONS The results of this study reveal multiple functionalities and immunological pathways affected by PF in humans, identify candidates for the development of fasting mimetic compounds, and uncover targets for investigation in longevity research.
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Affiliation(s)
| | - Chenghao Zhu
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Joanne Agus
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Xinyu Tang
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Qianyan Li
- Department of Molecular and Cellular Biology, University of California, Davis, Davis, CA
| | - JoAnne Engebrecht
- Department of Molecular and Cellular Biology, University of California, Davis, Davis, CA
| | - Angela M Zivkovic
- Department of Nutrition, University of California, Davis, Davis, CA.
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Association of Advanced Lipoprotein Subpopulation Profiles with Insulin Resistance and Inflammation in Patients with Type 2 Diabetes Mellitus. J Clin Med 2023; 12:jcm12020487. [PMID: 36675414 PMCID: PMC9864672 DOI: 10.3390/jcm12020487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 01/11/2023] Open
Abstract
Plasma lipoproteins exist as several subpopulations with distinct particle number and size that are not fully reflected in the conventional lipid panel. In this study, we sought to quantify lipoprotein subpopulations in patients with type 2 diabetes mellitus (T2DM) to determine whether specific lipoprotein subpopulations are associated with insulin resistance and inflammation markers. The study included 57 patients with T2DM (age, 61.14 ± 9.99 years; HbA1c, 8.66 ± 1.60%; mean body mass index, 35.15 ± 6.65 kg/m2). Plasma lipoprotein particles number and size were determined by nuclear magnetic resonance spectroscopy. Associations of different lipoprotein subpopulations with lipoprotein insulin resistance (LPIR) score and glycoprotein acetylation (GlycA) were assessed using multi-regression analysis. In stepwise regression analysis, VLDL and HDL large particle number and size showed the strongest associations with LPIR (R2 = 0.960; p = 0.0001), whereas the concentrations of the small VLDL and HDL particles were associated with GlycA (R2 = 0.190; p = 0.008 and p = 0.049, respectively). In adjusted multi-regression analysis, small and large VLDL particles and all sizes of lipoproteins independently predicted LPIR, whereas only the number of small LDL particles predicted GlycA. Conventional markers HbA1c and Hs-CRP did not exhibit any significant association with lipoprotein subpopulations. Our data suggest that monitoring insulin resistance-induced changes in lipoprotein subpopulations in T2DM might help to identify novel biomarkers that can be useful for effective clinical intervention.
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Fosam A, Bansal R, Ramanathan A, Sarcone C, Iyer I, Murthy M, Remaley AT, Muniyappa R. Lipoprotein Insulin Resistance Index: A Simple, Accurate Method for Assessing Insulin Resistance in South Asians. J Endocr Soc 2022; 7:bvac189. [PMID: 36636252 PMCID: PMC9830979 DOI: 10.1210/jendso/bvac189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Context Identification of insulin resistance (IR) in South Asians, who are at a higher risk for type 2 diabetes, is important. Lack of standardization of insulin assays limits the clinical use of insulin-based surrogate indices. The lipoprotein insulin resistance index (LP-IR), a metabolomic marker, reflects the lipoprotein abnormalities observed in IR. The reliability of the LP-IR index in South Asians is unknown. Objective We evaluated the predictive accuracy of LP-IR compared with other IR surrogate indices in South Asians. Methods In a cross-sectional study (n = 55), we used calibration model analysis to assess the ability of the LP-IR score and other simple surrogate indices (Homeostatic Model Assessment of Insulin Resistance, Quantitative insulin sensitivity check index, Adipose insulin resistance index, and Matsuda Index) to predict insulin sensitivity (SI) derived from the reference frequently sampled intravenous glucose tolerance test. LP-IR index was derived from lipoprotein particle concentrations and sizes measured by nuclear magnetic resonance spectroscopy. Predictive accuracy was determined by root mean squared error (RMSE) of prediction and leave-one-out cross-validation type RMSE of prediction (CVPE). The optimal cut-off of the LP-IR index was determined by the area under the receiver operating characteristic curve (AUROC) and the Youden index. Results The simple surrogate indices showed moderate correlations with SI (r = 0.53-0.69, P < .0001). CVPE and RMSE were not different in any of the surrogate indices when compared with LP-IR. The AUROC was 0.77 (95% CI 0.64-0.89). The optimal cut-off for IR in South Asians was LP-IR >48 (sensitivity: 75%, specificity: 70%). Conclusion The LP-IR index is a simple, accurate, and clinically useful test to assess IR in South Asians.
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Affiliation(s)
- Andin Fosam
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rashika Bansal
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amrita Ramanathan
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Camila Sarcone
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Indiresha Iyer
- Department of Cardiovascular Medicine, Cleveland Clinic, Akron, OH 44302, USA
| | - Meena Murthy
- Department of Endocrinology, Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Ranganath Muniyappa
- Correspondence: Ranganath Muniyappa, MD, PhD, Clinical Endocrine Section, Diabetes, Endocrinology and Obesity Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive MSC 1613, Building 10, CRC, Rm 6-3952, Bethesda, MD 20892-1613, USA.
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9
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Canet F, Christensen JJ, Victor VM, Hustad KS, Ottestad I, Rundblad A, Sæther T, Dalen KT, Ulven SM, Holven KB, Telle-Hansen VH. Glycated Proteins, Glycine, Acetate, and Monounsaturated Fatty Acids May Act as New Biomarkers to Predict the Progression of Type 2 Diabetes: Secondary Analyses of a Randomized Controlled Trial. Nutrients 2022; 14:nu14235165. [PMID: 36501195 PMCID: PMC9738624 DOI: 10.3390/nu14235165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Food protein or food-derived peptides may regulate blood glucose levels; however, studies have shown inconsistent results. The aim of the present study was to characterize subgroups of individuals with increased risk of type 2 diabetes (T2D) and to investigate the cardiometabolic effects of fish protein in the same subgroups. We first divided participants into high insuliniAUC and low insuliniAUC subjects based on their insulin incremental area under the curve (iAUC) levels after a 2 h oral glucose tolerance test (OGTT), and secondly based on whether they had received 5.2 g salmon fish protein or placebo for 8 weeks, in a previously conducted randomized controlled trial (RCT). We then profiled these groups by analyzing plasma metabolomics and peripheral blood mononuclear cell (PBMC) gene expression. Compared to the low insuliniAUC group, the high insuliniAUC group had higher plasma concentrations of monounsaturated fatty acids (MUFAs) and glycated proteins (GlycA) and lower concentrations of glycine and acetate. After intervention with fish protein compared to placebo, however, only acetate was significantly increased in the low insuliniAUC group. In conclusion, we identified metabolic biomarkers known to be associated with T2D; also, intervention with fish protein did not affect cardiometabolic risk markers in subgroups with increased risk of T2D.
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Affiliation(s)
- Francisco Canet
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 40617 Valencia, Spain
| | - Jacob J. Christensen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
| | - Victor M. Victor
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 40617 Valencia, Spain
- Department of Physiology, School of Medicine, University of Valencia, Av Blasco Ibáñez 13, 46010 Valencia, Spain
| | - Kristin S. Hustad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
| | - Amanda Rundblad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
| | - Thomas Sæther
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway
| | - Knut Tomas Dalen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
| | - Stine M. Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
| | - Kirsten B. Holven
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital Rikshospitalet, 0424 Oslo, Norway
| | - Vibeke H. Telle-Hansen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
- Correspondence:
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10
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Effects of a yoga-based stress reduction intervention on stress, psychological outcomes and cardiometabolic biomarkers in cancer caregivers: A randomized controlled trial. PLoS One 2022; 17:e0277009. [DOI: 10.1371/journal.pone.0277009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022] Open
Abstract
Caregiving stress is a risk factor for cardiometabolic disease. Therefore, integrating cardiometabolic biomarkers into caregiving research provides a more comprehensive assessment of an individual’s health and response to an intervention. The objective of this study was to examine the effects of a yoga-based stress reduction intervention on stress, psychological outcomes, and cardiometabolic biomarkers in cancer caregivers. This prospective randomized controlled trial enrolled family caregivers of adult patients who underwent an allogeneic HSCT at the National Institutes of Health (NIH) Clinical Center. All subjects received usual care education. Participants in the intervention group received an Iyengar yoga intervention self-administered over six weeks using an audio recording file. The primary outcome was perceived stress (measured using the NIH toolbox Perceived Stress). The secondary outcomes were psychological factors (depression and anxiety measured using PROMIS® Depression and Anxiety), and cardiometabolic biomarkers measured by nuclear magnetic resonance spectroscopy. A total of 50 family caregivers (mean [SD] age, 44.9 [15.2] years; 42 [84.0%] women) were randomized, 25 to the intervention group and 25 to the control group. No group differences were noted in stress, depression, and anxiety. Significant interaction effects between group and time were found in large TRL-P (F(1,43) = 10.16, p = 0.003) and LP-IR (F(1,42) = 4.28, p = 0.045). Post-hoc analyses revealed that the levels of large TRL-P (mean difference = 1.68, CI = [0.86, 2.51], p< .001) and LP-IR (mean difference = 5.67, CI = [1.15, 10.18], p = 0.015) significantly increased over time in the control group but while remained stable in the intervention group (mean difference = -0.15, CI = [-0.96, 0.66], p = 0.718; mean difference = -0.81, CI = [-5.22, 3.61], p = 0.714, respectively). Even when perceptions of psychological distress remain unchanged, incorporating gentle yoga poses and breathing exercises may reduce the risk of cardiometabolic disease in caregivers by inhibiting the development of insulin resistance. Standard lipids of cardiometabolic risk do not appear to be robust enough to detect short-term early changes of cardiometabolic risk in caregivers.
Trial registration: ClinicalTrials.gov Identifier: NCT02257853.
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11
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Bragg F, Kartsonaki C, Guo Y, Holmes M, Du H, Yu C, Pei P, Yang L, Jin D, Chen Y, Schmidt D, Avery D, Lv J, Chen J, Clarke R, Hill MR, Li L, Millwood IY, Chen Z. The role of NMR-based circulating metabolic biomarkers in development and risk prediction of new onset type 2 diabetes. Sci Rep 2022; 12:15071. [PMID: 36064959 PMCID: PMC9445062 DOI: 10.1038/s41598-022-19159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/25/2022] [Indexed: 11/08/2022] Open
Abstract
Associations of circulating metabolic biomarkers with type 2 diabetes (T2D) and their added value for risk prediction are uncertain among Chinese adults. A case-cohort study included 882 T2D cases diagnosed during 8-years' follow-up and a subcohort of 789 participants. NMR-metabolomic profiling quantified 225 plasma biomarkers in stored samples taken at recruitment into the study. Cox regression yielded adjusted hazard ratios (HRs) for T2D associated with individual biomarkers, with a set of biomarkers incorporated into an established T2D risk prediction model to assess improvement in discriminatory ability. Mean baseline BMI (SD) was higher in T2D cases than in the subcohort (25.7 [3.6] vs. 23.9 [3.6] kg/m2). Overall, 163 biomarkers were significantly and independently associated with T2D at false discovery rate (FDR) controlled p < 0.05, and 138 at FDR-controlled p < 0.01. Branched chain amino acids (BCAA), apolipoprotein B/apolipoprotein A1, triglycerides in VLDL and medium and small HDL particles, and VLDL particle size were strongly positively associated with T2D (HRs 1.74-2.36 per 1 SD, p < 0.001). HDL particle size, cholesterol concentration in larger HDL particles and docosahexaenoic acid levels were strongly inversely associated with T2D (HRs 0.43-0.48, p < 0.001). With additional adjustment for plasma glucose, most associations (n = 147 and n = 129 at p < 0.05 and p < 0.01, respectively) remained significant. HRs appeared more extreme among more centrally adipose participants for apolipoprotein B/apolipoprotein A1, BCAA, HDL particle size and docosahexaenoic acid (p for heterogeneity ≤ 0.05). Addition of 31 selected biomarkers to an established T2D risk prediction model modestly, but significantly, improved risk discrimination (c-statistic 0.86 to 0.91, p < 0.001). In relatively lean Chinese adults, diverse metabolic biomarkers are associated with future risk of T2D and can help improve established risk prediction models.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Michael Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Donghui Jin
- Hunan Centre for Disease Control and Prevention, Furong Mid Road, Changsha, Hunan, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dan Schmidt
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Daniel Avery
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael R Hill
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK.
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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12
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Insulin resistance in children. Curr Opin Pediatr 2022; 34:400-406. [PMID: 35796641 DOI: 10.1097/mop.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Insulin resistance (IR) is a clinical condition due to the decline in the efficiency of insulin promoting glucose uptake and utilization. The aim of this review is to provide an overview of the current knowledge on IR in children, focusing on its physiopathology, the most appropriate methods of measurement of IR, the assessment of risk factors, the effects of IR in children, and finally giving indications on screening and treatment. RECENT FINDINGS IR has evolved more and more to be a global public health problem associated with several chronic metabolic diseases. SUMMARY Detecting a correct measurement method and specific risk predictors, in order to reduce the incidence of IR, represents a challenging goal.
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Lawitz EJ, Li KW, Nyangau E, Field TJ, Chuang JC, Billin A, Wang L, Wang Y, Huss RS, Chung C, Subramanian GM, Myers RP, Hellerstein MK. Elevated de novo lipogenesis, slow liver triglyceride turnover and clinical correlations in nonalcoholic steatohepatitis patients. J Lipid Res 2022; 63:100250. [PMID: 35835205 PMCID: PMC9424583 DOI: 10.1016/j.jlr.2022.100250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/19/2022] Open
Abstract
De novo lipogenesis (DNL) converts carbon substrates to lipids. Increased hepatic DNL could contribute to pathogenic liver triglyceride accumulation in nonalcoholic steatohepatitis (NASH) and therefore may be a potential target for pharmacological intervention. Here, we measured hepatic DNL using heavy water in 123 NASH patients with fibrosis or cirrhosis, calculated the turnover of hepatic triglycerides to allow repeat labeling studies and determined the associations of hepatic DNL with metabolic, fibrotic, and imaging markers. We found that hepatic DNL was higher in fibrotic NASH patients [median (IQR), 40.7% contribution to palmitate (32.1, 47.5), n=103] than has been previously reported in healthy volunteers and remained elevated [median (IQR), 36.8% (31.0, 44.5), n=20] in patients with cirrhosis, despite lower liver fat content. We also showed that turnover of intrahepatic triglyceride pools was slow (t½ >10 days). Furthermore, DNL contribution was determined to be independent of liver stiffness by magnetic resonance imaging, but was positively associated with the number of large very low-density lipoprotein (VLDL) particles, the size of VLDL, the lipoprotein insulin resistance score, and levels of ApoB100 (r=0.6, p=0.07), and trended towards negative associations with the fibrosis markers FIB-4, FibroSure and APRI. Finally, we found treatment with the acetyl-CoA carboxylase inhibitor firsocostat reduced hepatic DNL at 4 and 12 weeks, using a correction model for residual label that accounts for hepatic triglyceride turnover. Taken together, these data support an important pathophysiological role for elevated hepatic DNL in NASH, and demonstrate that response to pharmacological agents targeting DNL can be correlated with pre-treatment DNL.
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Affiliation(s)
- Eric J Lawitz
- Texas Liver Institute, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Kelvin W Li
- Department of Nutritional Sciences & Toxicology, University of California Berkeley, Berkeley, California, USA
| | - Edna Nyangau
- Department of Nutritional Sciences & Toxicology, University of California Berkeley, Berkeley, California, USA
| | - Tyler John Field
- Department of Nutritional Sciences & Toxicology, University of California Berkeley, Berkeley, California, USA
| | | | | | - Lulu Wang
- Gilead Sciences, Inc., Foster City, Californi, USA
| | - Ya Wang
- Gilead Sciences, Inc., Foster City, Californi, USA
| | - Ryan S Huss
- Gilead Sciences, Inc., Foster City, Californi, USA
| | - Chuhan Chung
- Gilead Sciences, Inc., Foster City, Californi, USA
| | | | | | - Marc K Hellerstein
- Department of Nutritional Sciences & Toxicology, University of California Berkeley, Berkeley, California, USA.
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Hohberg V, Kreppke JN, Kohl J, Seelig E, Zahner L, Streckmann F, Gerber M, König D, Faude O. Effectiveness of a personal health coaching intervention (diabetescoach) in patients with type 2 diabetes: protocol for an open-label, pragmatic randomised controlled trial. BMJ Open 2022; 12:e057948. [PMID: 35649615 PMCID: PMC9161069 DOI: 10.1136/bmjopen-2021-057948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/28/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The widespread prevalence of type 2 diabetes (T2D) not only influences patients' daily lives but also has an economic impact on society. Increasing physical activity and a healthy diet can delay the progression of T2D. Although there are evidence-based recommendations on diet and physical activity, patients with T2D have difficulties implementing them. An appropriate lifestyle intervention can address this problem. METHODS AND ANALYSIS This study is based on the need to develop an intervention that helps patients to establish behavioural changes in order to achieve glycaemic control. The intervention will be evaluated in a monocentric, open-label, pragmatic, two-arm randomised controlled trial with a sample ratio of 1:1 and a parallel design. This superiority study will be conducted in Switzerland. All enrolled patients (n=90) will receive the standard medical treatment for T2D. The intervention group will receive personal health coaching by telephone and access to a smartphone and web application for 1 year. The control group will receive access to the application for 1 year and a one-time written diet and exercise recommendation. The primary outcomes are objectively measured physical activity and glycated haemoglobin. Secondary outcomes are self-reported physical activity, nutrition, cognitive mediators of changes in sport-related behaviour, blood values, medication and nutritional supplements, anthropometric data, quality of life, neuropathy and cost-effectiveness. All outcomes will be measured at baseline, at 27 weeks after inclusion and at 54 weeks after inclusion. The recruitment of participants and the measurements will be completed after 2 years. Linear mixed-effects models will be applied for each outcome variable to analyse the intervention effects. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee North-western and Central Switzerland in February 2021 (ref: 2020-02755). All participants will be required to provide written informed consent. The results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN79457541.
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Affiliation(s)
- Vivien Hohberg
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jan-Niklas Kreppke
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jan Kohl
- Institute of Sports and Sport Science, University of Freiburg, Freiburg im Breisgau, Germany
| | - Eleonora Seelig
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Endocrinology and Diabetology, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Lukas Zahner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Fiona Streckmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Onkology, University Hospital Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Daniel König
- Institute of Sports and Sport Science, University of Freiburg, Freiburg im Breisgau, Germany
- Institute for Nutrition, Exercise and Health, University of Vienna, Wien, Austria
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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15
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Flores-Guerrero JL, Connelly MA, Shalaurova I, Garcia E, Bakker SJL, Dullaart RPF. A metabolomic index based on lipoprotein subfractions and branched chain amino acids is associated with incident hypertension. Eur J Intern Med 2021; 94:56-63. [PMID: 34321184 DOI: 10.1016/j.ejim.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The present study aims to evaluate the performance of the Diabetes Risk Index (DRI), a metabolomic index based on lipoprotein particles and branched chain amino acids, on the incidence of newly developed hypertension in a large community dwelling cohort. METHODS The DRI was calculated by combining 6 lipoprotein parameters [sizes of very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), concentrations of large VLDL, small LDL, and large HDL particles], and the concentrations of valine and leucine. DRI scores were estimated in 4169 participants from the PREVEND prospective cohort. Cox proportional hazards regression was used to evaluate the association of DRI scores with incident hypertension. RESULTS During a median follow-up of 8.6 years, 924 new hypertension cases were ascertained. In analyses adjusted for age and sex, there was a significant association between DRI and incident hypertension with a hazard ratio (HR) per 1 SD increase of 1.45 (95% CI 1.36,1.54; p < 0.001). After additional adjustment for traditional risk factors, the HR remained significant (HRadj 1.21, 95% CI 1.10, 1.33, p <0.001). Likewise, subjects in the top quartile of DRI presented with a higher risk of hypertension (HRadj 1.64, 95% CI 1.28, 2.10, p <0.001). Furthermore, the net reclassification improvement assessment improved after the addition of DRI to a traditional risk model (p <0.001), allowing proper reclassification of 34% of the participants. CONCLUSION Higher DRI scores were associated with an increased risk of incident hypertension. Such association was independent of traditional clinical risk factors for hypertension.
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Affiliation(s)
- Jose L Flores-Guerrero
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands..
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Irina Shalaurova
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Erwin Garcia
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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16
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Ebbeling CB, Knapp A, Johnson A, Wong JMW, Greco KF, Ma C, Mora S, Ludwig DS. Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia-a randomized controlled feeding trial. Am J Clin Nutr 2021; 115:154-162. [PMID: 34582545 PMCID: PMC8755039 DOI: 10.1093/ajcn/nqab287] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Carbohydrate restriction shows promise for diabetes, but concerns regarding high saturated fat content of low-carbohydrate diets limit widespread adoption. OBJECTIVES This preplanned ancillary study aimed to determine how diets varying widely in carbohydrate and saturated fat affect cardiovascular disease (CVD) risk factors during weight-loss maintenance. METHODS After 10-14% weight loss on a run-in diet, 164 participants (70% female; BMI = 32.4 ± 4.8 kg/m2) were randomly assigned to 3 weight-loss maintenance diets for 20 wk. The prepared diets contained 20% protein and differed 3-fold in carbohydrate (Carb) and saturated fat as a proportion of energy (Low-Carb: 20% carbohydrate, 21% saturated fat; Moderate-Carb: 40%, 14%; High-Carb: 60%, 7%). Fasting plasma samples were collected prerandomization and at 20 wk. Lipoprotein insulin resistance (LPIR) score was calculated from triglyceride-rich, high-density, and low-density lipoprotein particle (TRL-P, HDL-P, LDL-P) sizes and subfraction concentrations (large/very large TRL-P, large HDL-P, small LDL-P). Other outcomes included lipoprotein(a), triglycerides, HDL cholesterol, LDL cholesterol, adiponectin, and inflammatory markers. Repeated measures ANOVA was used for intention-to-treat analysis. RESULTS Retention was 90%. Mean change in LPIR (scale 0-100) differed by diet in a dose-dependent fashion: Low-Carb (-5.3; 95% CI: -9.2, -1.5), Moderate-Carb (-0.02; 95% CI: -4.1, 4.1), High-Carb (3.6; 95% CI: -0.6, 7.7), P = 0.009. Low-Carb also favorably affected lipoprotein(a) [-14.7% (95% CI: -19.5, -9.5), -2.1 (95% CI: -8.2, 4.3), and 0.2 (95% CI: -6.0, 6.8), respectively; P = 0.0005], triglycerides, HDL cholesterol, large/very large TRL-P, large HDL-P, and adiponectin. LDL cholesterol, LDL-P, and inflammatory markers did not differ by diet. CONCLUSIONS A low-carbohydrate diet, high in saturated fat, improved insulin-resistant dyslipoproteinemia and lipoprotein(a), without adverse effect on LDL cholesterol. Carbohydrate restriction might lower CVD risk independently of body weight, a possibility that warrants study in major multicentered trials powered on hard outcomes. The registry is available through ClinicialTrials.gov: https://clinicaltrials.gov/ct2/show/NCT02068885.
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Affiliation(s)
- Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's
Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA,
USA
| | - Amy Knapp
- Department of Biology, Framingham State University,
Framingham, MA, USA
| | - Ann Johnson
- Department of Food and Nutrition, Framingham State
University, Framingham, MA, USA
| | - Julia M W Wong
- New Balance Foundation Obesity Prevention Center, Boston Children's
Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA,
USA
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research, Boston
Children's Hospital, Boston, MA, USA
| | - Clement Ma
- Harvard Medical School, Boston, MA,
USA,Dana-Farber/Boston Children's Cancer and Blood Disorders
Center, Boston, MA, USA
| | - Samia Mora
- Harvard Medical School, Boston, MA,
USA,Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular
Medicine, Brigham and Women's Hospital, Boston,
MA, USA
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Richter CK, Skulas-Ray AC, Gaugler TL, Meily S, Petersen KS, Kris-Etherton PM. Effects of Cranberry Juice Supplementation on Cardiovascular Disease Risk Factors in Adults with Elevated Blood Pressure: A Randomized Controlled Trial. Nutrients 2021; 13:nu13082618. [PMID: 34444779 PMCID: PMC8398037 DOI: 10.3390/nu13082618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 07/24/2021] [Indexed: 12/19/2022] Open
Abstract
Emerging cardiovascular disease (CVD) risk factors, including central vascular function and HDL efflux, may be modifiable with food-based interventions such as cranberry juice. A randomized, placebo-controlled, crossover trial was conducted in middle-aged adults with overweight/obesity (n = 40; mean BMI: 28.7 ± 0.8 kg/m2; mean age: 47 ± 2 years) and elevated brachial blood pressure (mean systolic/diastolic BP: 124 ± 2/81 ± 1 mm Hg). Study participants consumed 500 mL/d of cranberry juice (~16 fl oz; 27% cranberry juice) or a matched placebo juice in a randomized order (8-week supplementation periods; 8-week compliance break), with blood samples and vascular measurements obtained at study entry and following each supplementation period. There was no significant treatment effect of cranberry juice supplementation on the primary endpoint of central systolic blood pressure or central or brachial diastolic pressure. Cranberry juice significantly reduced 24-h diastolic ambulatory BP by ~2 mm Hg compared to the placebo (p = 0.05) during daytime hours. Cranberry juice supplementation did not alter LDL-C but significantly changed the composition of the lipoprotein profile compared to the placebo, increasing the concentration of large LDL-C particles (+29.5 vs. −6.7 nmol/L; p = 0.02) and LDL size (+0.073 vs. −0.068 nm; p = 0.001). There was no effect of treatment on ex vivo HDL efflux in the total population, but exploratory subgroup analyses identified an interaction between BMI and global HDL efflux (p = 0.02), with greater effect of cranberry juice in participants who were overweight. Exploratory analyses indicate that baseline C-reactive protein (CRP) values may moderate treatment effects. In this population of adults with elevated blood pressure, cranberry juice supplementation had no significant effect on central systolic blood pressure but did have modest effects on 24-h diastolic ambulatory BP and the lipoprotein profile. Future studies are needed to verify these findings and the results of our exploratory analyses related to baseline health moderators.
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Affiliation(s)
- Chesney K. Richter
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85716, USA; (C.K.R.); (A.C.S.-R.)
| | - Ann C. Skulas-Ray
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85716, USA; (C.K.R.); (A.C.S.-R.)
| | - Trent L. Gaugler
- Department of Mathematics, Lafayette College, Easton, PA 18042, USA;
| | - Stacey Meily
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (S.M.); (K.S.P.)
| | - Kristina S. Petersen
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (S.M.); (K.S.P.)
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Penny M. Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (S.M.); (K.S.P.)
- Correspondence:
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18
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Hamaya R, Mora S, Lawler PR, Cook NR, Ridker PM, Buring JE, Lee IM, Manson JE, Tobias DK. Association of Plasma Branched-Chain Amino Acid With Biomarkers of Inflammation and Lipid Metabolism in Women. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003330. [PMID: 34264743 DOI: 10.1161/circgen.121.003330] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Branched-chain amino acids (BCAAs; isoleucine, leucine, and valine) correlate with insulin resistance and poor glucose control, which may in part explain associations between type 2 diabetes and cardiovascular disease. However, the relationships of BCAAs with other cardiometabolic pathways, including inflammation and dyslipidemia, are unclear. We hypothesized that plasma BCAAs would correlate with multiple pathways of cardiometabolic dysfunction. METHODS We conducted a cross-sectional analysis among 19 472 participants (mean age=54.9 years, SD=7.2 years) in the Women's Health Study without a history of type 2 diabetes, cardiovascular disease, or cancer. We quantified the concentrations of individual biomarkers of inflammation and lipids, across quartiles of BCAAs, adjusting for age, smoking, body mass index, physical activity, and other established cardiovascular disease risk factors at blood draw. RESULTS Women in the highest versus lowest quartiles of plasma BCAAs had higher inflammatory markers including high-sensitivity C-reactive protein (multivariable-adjusted means: 1.96 versus 1.43 mg/L), fibrinogen (367 versus 362 mg/dL), soluble intercellular cell adhesion molecule-1 (361 versus 353 ng/mL), and glycoprotein acetylation (407 versus 371 µmol/L; P trend=0.0002 for fibrinogen; P<0.0001 for others). Similarly for lipids, women with higher BCAAs had lower HDL-C (high-density lipoprotein cholesterol; 49.0 versus 55.0 mg/dL), and higher triglycerides (143 versus 114 mg/dL), LDL-C (low-density lipoprotein cholesterol; 133 versus 124 mg/dL), and lipoprotein insulin resistance score (52.6 versus 37.3; all: P<0.0001). Similar associations with these biomarkers were observed in isoleucine, leucine, and valine, respectively. CONCLUSIONS Higher circulating BCAA concentrations are associated with adverse profiles of biomarkers of inflammation and dyslipidemia independent of established cardiovascular disease risk factors, and thus, may reflect poorer cardiometabolic health through multiple pathways. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000479.
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Affiliation(s)
- Rikuta Hamaya
- Division of Preventive Medicine, Department of Medicine (R.H., S.M., N.R.C., P.M.R., J.E.B., I.L., J.E.M., D.K.T.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Nutrition (R.H., D.K.T.), Harvard T.H
| | - Samia Mora
- Division of Preventive Medicine, Department of Medicine (R.H., S.M., N.R.C., P.M.R., J.E.B., I.L., J.E.M., D.K.T.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Lipid Metabolomics, Division of Cardiovascular Medicine (S.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrick R Lawler
- Chan School of Public Health, Boston, MA. Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.)
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine (R.H., S.M., N.R.C., P.M.R., J.E.B., I.L., J.E.M., D.K.T.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Epidemiology (N.R.C., J.E.B., I.L., J.E.M.), Harvard T.H
| | - Paul M Ridker
- Division of Preventive Medicine, Department of Medicine (R.H., S.M., N.R.C., P.M.R., J.E.B., I.L., J.E.M., D.K.T.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine (R.H., S.M., N.R.C., P.M.R., J.E.B., I.L., J.E.M., D.K.T.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Mary Horrigan Connors Center for Women's Health and Gender Biology (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Epidemiology (N.R.C., J.E.B., I.L., J.E.M.), Harvard T.H
| | - I-Min Lee
- Department of Epidemiology (N.R.C., J.E.B., I.L., J.E.M.), Harvard T.H
| | - JoAnn E Manson
- Department of Epidemiology (N.R.C., J.E.B., I.L., J.E.M.), Harvard T.H
| | - Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine (R.H., S.M., N.R.C., P.M.R., J.E.B., I.L., J.E.M., D.K.T.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Nutrition (R.H., D.K.T.), Harvard T.H
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19
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Sharma VR, Matta ST, Haymond MW, Chung ST. Measuring Insulin Resistance in Humans. Horm Res Paediatr 2021; 93:577-588. [PMID: 33934092 PMCID: PMC8162778 DOI: 10.1159/000515462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Insulin resistance is a pathophysiological condition associated with diabetes and cardiometabolic diseases that is characterized by a diminished tissue response to insulin action. Our understanding of this complex phenomenon and its role in the pathogenesis of cardiometabolic diseases is rooted in the discovery of insulin, its isolation and purification, and the challenges encountered with its therapeutic use. SUMMARY In this historical perspective, we explore the evolution of the term "insulin resistance" and demonstrate how advances in insulin and glucose analytics contributed to the recognition and validation of this metabolic entity. We identify primary discoveries which were pivotal in expanding our knowledge of insulin resistance, the challenges in measurement and interpretation, contemporary techniques, and areas of future exploration. Key Message: Measurements of insulin resistance are important tools for defining and treating cardiometabolic diseases. Accurate quantification of this pathophysiological entity requires careful consideration of the assumptions and pitfalls of the methodological techniques and the historical and clinical context when interpreting and applying the results.
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Affiliation(s)
- Vandhna R. Sharma
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Samantha T. Matta
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Stephanie T. Chung
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA,*Stephanie T. Chung,
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20
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Vittal A, Shapses M, Sharma B, Sharma D, Sun Q, Sampson M, Lee W, Ben Yakov G, Rotman Y. Lipoprotein Insulin Resistance Index Reflects Liver Fat Content in Patients With Nonalcoholic Fatty Liver Disease. Hepatol Commun 2021; 5:589-597. [PMID: 33860117 PMCID: PMC8034570 DOI: 10.1002/hep4.1658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/08/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
The recently developed lipoprotein insulin resistance index (LP-IR) incorporates lipoprotein particle numbers and sizes and is considered to reflect both hepatic and peripheral IR. As tissue IR is a strong component of nonalcoholic fatty liver disease (NAFLD) pathogenesis, we aimed to assess the degree by which LP-IR associates with hepatic fat content. This was a single-center retrospective analysis of patients with NAFLD. LP-IR, the homeostasis model assessment of insulin resistance (HOMA-IR), and adipose tissue IR (Adipo-IR) were measured simultaneously. Liver fat content was estimated by FibroScan controlled attenuated parameter. Associations were assessed using Spearman's correlation and multivariate linear regression. The study included 61 patients. LP-IR was correlated with HOMA-IR (ρ = 0.30; P = 0.02), typically thought to reflect hepatic IR, but not with Adipo-IR (ρ = 0.15; P = 0.25). Liver fat content was significantly associated with Adipo-IR (ρ = 0.48; P < 0.001), LP-IR (ρ = 0.35; P = 0.005), and to a lesser degree with HOMA-IR (ρ = 0.25; P = 0.051). The association of liver fat with LP-IR was limited to patients without diabetes (ρ = 0.60; P < 0.0001), whereas no association was seen in those with diabetes. In a multivariate model, Adipo-IR, LP-IR, and diabetes were independently associated with liver fat and together explained 35% of the variability in liver fat. Conclusion: LP-IR is a reasonable measure of IR in non-diabetic patients with NAFLD and is associated with hepatic fat content. Although adipose tissue is the major contributor to liver fat, the additional contribution of nonadipose tissues can be easily estimated using LP-IR.
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Affiliation(s)
- Anusha Vittal
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA
| | - Mark Shapses
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA
| | - Bashar Sharma
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA.,Department of MedicineState University of New York Upstate Medical UniversitySyracuseNYUSA
| | - Disha Sharma
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA
| | - Qian Sun
- Department of Laboratory MedicineNational Institutes of Health Clinical CenterNational Institutes of HealthBethesdaMDUSA
| | - Maureen Sampson
- Department of Laboratory MedicineNational Institutes of Health Clinical CenterNational Institutes of HealthBethesdaMDUSA
| | - Wilson Lee
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA.,Department of MedicineMedstar Baltimore ProgramBaltimoreMDUSA
| | - Gil Ben Yakov
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA
| | - Yaron Rotman
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA
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21
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Dugani SB, Moorthy MV, Li C, Demler OV, Alsheikh-Ali AA, Ridker PM, Glynn RJ, Mora S. Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women. JAMA Cardiol 2021; 6:437-447. [PMID: 33471027 PMCID: PMC7818181 DOI: 10.1001/jamacardio.2020.7073] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Risk profiles for premature coronary heart disease (CHD) are unclear. Objective To examine baseline risk profiles for incident CHD in women by age at onset. Design, Setting, and Participants A prospective cohort of US female health professionals participating in the Women's Health Study was conducted; median follow-up was 21.4 years. Participants included 28 024 women aged 45 years or older without known cardiovascular disease. Baseline profiles were obtained from April 30, 1993, to January 24, 1996, and analyses were conducted from October 1, 2017, to October 1, 2020. Exposures More than 50 clinical, lipid, inflammatory, and metabolic risk factors and biomarkers. Main Outcomes and Measures Four age groups were examined (<55, 55 to <65, 65 to <75, and ≥75 years) for CHD onset, and adjusted hazard ratios (aHRs) were calculated using stratified Cox proportional hazard regression models with age as the time scale and adjusting for clinical factors. Women contributed to different age groups over time. Results Of the clinical factors in the women, diabetes had the highest aHR for CHD onset at any age, ranging from 10.71 (95% CI, 5.57-20.60) at CHD onset in those younger than 55 years to 3.47 (95% CI, 2.47-4.87) at CHD onset in those 75 years or older. Risks that were also noted for CHD onset in participants younger than 55 years included metabolic syndrome (aHR, 6.09; 95% CI, 3.60-10.29), hypertension (aHR, 4.58; 95% CI, 2.76-7.60), obesity (aHR, 4.33; 95% CI, 2.31-8.11), and smoking (aHR, 3.92; 95% CI, 2.32-6.63). Myocardial infarction in a parent before age 60 years was associated with 1.5- to 2-fold risk of CHD in participants up to age 75 years. From approximately 50 biomarkers, lipoprotein insulin resistance had the highest standardized aHR: 6.40 (95% CI, 3.14-13.06) for CHD onset in women younger than 55 years, attenuating with age. In comparison, weaker but significant associations with CHD in women younger than 55 years were noted (per SD increment) for low-density lipoprotein cholesterol (aHR, 1.38; 95% CI, 1.10-1.74), non-high-density lipoprotein cholesterol (aHR, 1.67; 95% CI, 1.36-2.04), apolipoprotein B (aHR, 1.89; 95% CI, 1.52-2.35), triglycerides (aHR, 2.14; 95% CI, 1.72-2.67), and inflammatory biomarkers (1.2- to 1.8-fold)-all attenuating with age. Some biomarkers had similar CHD age associations (eg, physical inactivity, lipoprotein[a], total high-density lipoprotein particles), while a few had no association with CHD onset at any age. Most risk factors and biomarkers had associations that attenuated with increasing age at onset. Conclusions and Relevance In this cohort study, diabetes and insulin resistance, in addition to hypertension, obesity, and smoking, appeared to be the strongest risk factors for premature onset of CHD. Most risk factors had attenuated relative rates at older ages.
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Affiliation(s)
- Sagar B Dugani
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Vinayaga Moorthy
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chunying Li
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olga V Demler
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert J Glynn
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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de Almeida-Pititto B, Dualib PM, Jordão MC, Izar Helfenstein Fonseca M, Jones SR, Blaha MJ, Toth PP, Santos RD, Bensenor IM, Ferreira SRG, Lotufo PA. Branched-chain amino acids predict incident diabetes in the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil. Diabetes Res Clin Pract 2021; 174:108747. [PMID: 33713721 DOI: 10.1016/j.diabres.2021.108747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/14/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
AIMS To evaluate the role of branch chain amino acid (BCAA) concentrations as a predictor for incident type 2 diabetes (DM). METHODS Participants from ELSA-Brasil without diabetes at baseline and followed for 3.9 ± 0.6 years were included in the analysis. The determinations of BCAA (valine, leucine, isoleucine) were performed by proton nuclear magnetic resonance spectroscopy. Cardiometabolic profile and incidence of DM were evaluated according to quartiles of BCAA at baseline, stratified by sex. RESULTS From 3,828 participants (56% female, 50.5 ± 8.7 years) 299 (8.5%) were diagnosed with DM. For both sexes, a worsening of cardiometabolic profile was observed across increasing BCAA quartiles. In survival analysis, incidence rates of DM for the entire period were highest in participants in the third and fourth quartile of BCAA (log Rank analysis < 0.001 for both sexes). In Cox regression analysis, for men, the HR (95%CI) for risk of DM was 2.24 (1.24-4.03) for those from the fourth quartile of BCAA, while in women it was 1.94 (1.07-3.50), comparing to first quartile of BCAA after adjustments for age, BMI, physical activity, family history of DM, pre-diabetes, blood pressure, total cholesterol and HOMA-IR. CONCLUSIONS Higher levels of BCAA were independently predictors of DM.
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Affiliation(s)
- Bianca de Almeida-Pititto
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740, CEP 04023900 São Paulo, Brazil; Programa de Pós-Graduação em Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Estado de Israel 639, CEP 04023900, São Paulo, Brazil.
| | - Patrícia M Dualib
- Programa de Pós-Graduação em Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Estado de Israel 639, CEP 04023900, São Paulo, Brazil.
| | - Martha C Jordão
- Programa de Pós-Graduação em Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Estado de Israel 639, CEP 04023900, São Paulo, Brazil.
| | | | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524 D1, 600 N. Wolfe St, Baltimore, MD, USA.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524 D1, 600 N. Wolfe St, Baltimore, MD, USA.
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524 D1, 600 N. Wolfe St, Baltimore, MD, USA; Department of Preventive Cardiology, CGH Medical Center, 100 E. Le Fevre Road 61081 Sterling, IL, USA.
| | - Raul D Santos
- Heart Institute (InCor), University of São Paulo Medical School Hospital, Av. Dr. Enéas de Carvalho Aguiar, 44, CEP 01246-000 São Paulo, Brazil.
| | - Isabela M Bensenor
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, Av. Lineu Prestes 2565 - 4° floor, CEP: 05508-000 São Paulo, SP, Brazil; Centro de Pesquisa do Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, CEP 05508-000 São Paulo, SP, Brazil
| | - Sandra Roberta G Ferreira
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil.
| | - Paulo A Lotufo
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, Av. Lineu Prestes 2565 - 4° floor, CEP: 05508-000 São Paulo, SP, Brazil; Centro de Pesquisa do Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, CEP 05508-000 São Paulo, SP, Brazil.
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23
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Varga TV, Liu J, Goldberg RB, Chen G, Dagogo-Jack S, Lorenzo C, Mather KJ, Pi-Sunyer X, Brunak S, Temprosa M. Predictive utilities of lipid traits, lipoprotein subfractions and other risk factors for incident diabetes: a machine learning approach in the Diabetes Prevention Program. BMJ Open Diabetes Res Care 2021; 9:9/1/e001953. [PMID: 33789908 PMCID: PMC8016090 DOI: 10.1136/bmjdrc-2020-001953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Although various lipid and non-lipid analytes measured by nuclear magnetic resonance (NMR) spectroscopy have been associated with type 2 diabetes, a structured comparison of the ability of NMR-derived biomarkers and standard lipids to predict individual diabetes risk has not been undertaken in larger studies nor among individuals at high risk of diabetes. RESEARCH DESIGN AND METHODS Cumulative discriminative utilities of various groups of biomarkers including NMR lipoproteins, related non-lipid biomarkers, standard lipids, and demographic and glycemic traits were compared for short-term (3.2 years) and long-term (15 years) diabetes development in the Diabetes Prevention Program, a multiethnic, placebo-controlled, randomized controlled trial of individuals with pre-diabetes in the USA (N=2590). Logistic regression, Cox proportional hazards model and six different hyperparameter-tuned machine learning algorithms were compared. The Matthews Correlation Coefficient (MCC) was used as the primary measure of discriminative utility. RESULTS Models with baseline NMR analytes and their changes did not improve the discriminative utility of simpler models including standard lipids or demographic and glycemic traits. Across all algorithms, models with baseline 2-hour glucose performed the best (max MCC=0.36). Sophisticated machine learning algorithms performed similarly to logistic regression in this study. CONCLUSIONS NMR lipoproteins and related non-lipid biomarkers were associated but did not augment discrimination of diabetes risk beyond traditional diabetes risk factors except for 2-hour glucose. Machine learning algorithms provided no meaningful improvement for discrimination compared with logistic regression, which suggests a lack of influential latent interactions among the analytes assessed in this study. TRIAL REGISTRATION NUMBER Diabetes Prevention Program: NCT00004992; Diabetes Prevention Program Outcomes Study: NCT00038727.
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Affiliation(s)
- Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Translational Disease Systems Biology Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | - Jinxi Liu
- Biostatistics Center and Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, Maryland, USA
| | | | - Guannan Chen
- Biostatistics Center and Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, Maryland, USA
| | | | - Carlos Lorenzo
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kieren J Mather
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Xavier Pi-Sunyer
- Columbia University Medical Center, New York City, New York, USA
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Translational Disease Systems Biology Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marinella Temprosa
- Biostatistics Center and Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, Maryland, USA
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24
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Ross LM, Slentz CA, Zidek AM, Huffman KM, Shalaurova I, Otvos JD, Connelly MA, Kraus VB, Bales CW, Houmard JA, Kraus WE. Effects of Amount, Intensity, and Mode of Exercise Training on Insulin Resistance and Type 2 Diabetes Risk in the STRRIDE Randomized Trials. Front Physiol 2021; 12:626142. [PMID: 33613319 PMCID: PMC7892901 DOI: 10.3389/fphys.2021.626142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
Background Lipoprotein Insulin Resistance Index (LP-IR) and Diabetes Risk Index are novel spectroscopic multimarkers of insulin resistance and type 2 diabetes risk. As the Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) randomized trials have previously demonstrated the ability of exercise training to improve traditional markers of insulin action, the aim of this study was to examine the effects of exercise amount, intensity, and mode on LP-IR and the Diabetes Risk Index. Methods A total of 503 adults with dyslipidemia [STRRIDE I (n = 194), STRRIDE AT/RT (n = 139)] or prediabetes [STRRIDE-PD (n = 170)] were randomized to control or one of 10 exercise interventions, ranging from doses of 8–23 kcal/kg/week; intensities of 50–75% V̇O2peak; and durations of 6–8 months. Two groups included resistance training and one included dietary intervention (7% weight loss goal). Fasting plasma samples were obtained at baseline and 16–24 h after the final exercise bout. LP-IR, the Diabetes Risk Index, and concentrations of the branched chain amino acids valine and leucine were determined using nuclear magnetic resonance spectroscopy. LP-IR and the Diabetes Risk Index scores range from 0–100 and 1–100, respectively (greater scores indicate greater risk). Paired t-tests determined significance within groups (p < 0.05). Results After training, six exercise groups significantly improved LP-IR (ranging from −4.4 ± 8.2 to −12.4 ± 14.1), and four exercise groups significantly improved the Diabetes Risk Index (ranging from −2.8 ± 8.2 to −8.3 ± 10.4). The most beneficial interventions for both LP-IR and the Diabetes Risk Index were low amount/moderate intensity aerobic, aerobic plus resistance, and aerobic plus diet. Summary Multiple exercise interventions improved LP-IR and the Diabetes Risk Index. In those with dyslipidemia, adding resistance to aerobic training elicited a synergistic effect on insulin resistance and type 2 diabetes risk. In individuals with prediabetes, combining a dietary intervention and weight loss with aerobic training resulted in the most robust type 2 diabetes risk improvement.
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Affiliation(s)
- Leanna M Ross
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Cris A Slentz
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Alyssa M Zidek
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Kim M Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Irina Shalaurova
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - Virginia B Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Connie W Bales
- Center for the Study of Aging, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, United States
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, Greenville, NC, United States
| | - William E Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
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25
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Chung ST, Matta ST, Meyers AG, Cravalho CK, Villalobos-Perez A, Dawson JM, Sharma VR, Sampson ML, Otvos JD, Magge SN. Nuclear Magnetic Resonance Derived Biomarkers for Evaluating Cardiometabolic Risk in Youth and Young Adults Across the Spectrum of Glucose Tolerance. Front Endocrinol (Lausanne) 2021; 12:665292. [PMID: 34084151 PMCID: PMC8167058 DOI: 10.3389/fendo.2021.665292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED Youth with obesity have an increased risk for cardiometabolic disease, but identifying those at highest risk remains a challenge. Four biomarkers that might serve this purpose are "by products" of clinical NMR LipoProfile® lipid testing: LPIR (Lipoprotein Insulin Resistance Index), GlycA (inflammation marker), BCAA (total branched-chain amino acids), and glycine. All are strongly related to insulin resistance and type 2 diabetes (T2DM) in adults (glycine inversely) and are independent of biological and methodological variations in insulin assays. However, their clinical utility in youth is unclear. We compared fasting levels of these biomarkers in 186 youth (42 lean normal glucose tolerant (NGT), 88 obese NGT, 23 with prediabetes (PreDM), and 33 with T2DM. All four biomarkers were associated with obesity and glycemia in youth. LPIR and GlycA were highest in youth with PreDM and T2DM, whereas glycine was lowest in youth with T2DM. While all four were correlated with HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LPIR had the strongest correlation (LPIR: r = 0.6; GlycA: r = 0.4, glycine: r = -0.4, BCAA: r = 0.2, all P < 0.01). All four markers correlated with HbA1c (LPIR, GlycA, BCAA: r ≥ 0.3 and glycine: r = -0.3, all P < 0.001). In multi-variable regression models, LPIR, GlycA, and glycine were independently associated with HOMA-IR (Adjusted R2 = 0.473, P < 0.001) and LPIR, glycine, and BCAA were independently associated with HbA1c (Adjusted R2 = 0.33, P < 0.001). An LPIR index of >44 was associated with elevated blood pressure, BMI, and dyslipidemia. Plasma NMR-derived markers were related to adverse markers of cardiometabolic risk in youth. LPIR, either alone or in combination with GlycA, should be explored as a non-insulin dependent predictive tool for development of insulin resistance and diabetes in youth. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, identifier NCT:02960659.
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Affiliation(s)
- Stephanie T. Chung
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Stephanie T. Chung,
| | - Samantha T. Matta
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Abby G. Meyers
- Department of Endocrinology and Diabetes, Children’s National Hospital, Washington, DC, United States
| | - Celeste K. Cravalho
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Alfredo Villalobos-Perez
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Joshua M. Dawson
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Vandhna R. Sharma
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Maureen L. Sampson
- National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - James D. Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - Sheela N. Magge
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Zhang R, Lin B, Parikh M, Fisher EA, Berger JS, Aleman JO, Heffron SP. Lipoprotein insulin resistance score in nondiabetic patients with obesity after bariatric surgery. Surg Obes Relat Dis 2020; 16:1554-1560. [PMID: 32636175 PMCID: PMC7541552 DOI: 10.1016/j.soard.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lipoprotein insulin resistance (LPIR) score is a composite biomarker representative of atherogenic dyslipidemia characteristic of early insulin resistance. It is elevated in obesity and may provide information not captured in glycosylated hemoglobin and homeostatic model assessment for insulin resistance. While bariatric surgery reduces diabetes incidence and resolves metabolic syndrome, the effect of bariatric surgery on LPIR is untested. OBJECTIVES We sought to assess the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on LPIR in nondiabetic women with obesity. SETTING Nonsmoking, nondiabetic, premenopausal Hispanic women, age ≥18 years, undergoing Roux-en-Y gastric bypass or sleeve gastrectomy at Bellevue Hospital were recruited for a prospective observational study. METHODS Anthropometric measures and blood sampling were performed preoperatively and at 6 and 12 months postoperatively. LPIR was measured by nuclear magnetic resonance spectroscopy. RESULTS Among 53 women (Roux-en-Y gastric bypass, n = 22; sleeve gastrectomy, n = 31), mean age was 32 ± 7 years and body mass index 44.1 ± 6.4 kg/m2. LPIR was reduced by 35 ± 4% and 46 ± 4% at 6 and 12 months after surgery, respectively, with no difference by procedure. Twenty-seven of 53 patients met International Diabetes Federation criteria for metabolic syndrome preoperatively and had concomitant higher homeostatic model assessment for insulin resistance, glycosylated hemoglobin, nonhigh-density lipoprotein-cholesterol and LPIR. Twenty-five of 27 patients experienced resolution of metabolic syndrome postoperatively. Concordantly, the preoperative differences in homeostatic model assessment for insulin resistance, glycosylated hemoglobin, and nonhigh-density lipoprotein-cholesterol between those with and without metabolic syndrome resolved at 6 and 12 months. In contrast, patients with metabolic syndrome preoperatively exhibited greater LPIR scores at 6 and 12 months postoperatively. CONCLUSION This is the first study to demonstrate improvement in insulin resistance, as measured by LPIR, after bariatric surgery with no difference by procedure. This measure, but not traditional markers, was persistently higher in patients with a preoperative metabolic syndrome diagnosis, despite resolution of the condition.
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Affiliation(s)
- Ruina Zhang
- Department of Medicine, Leon H. Charney Division of Cardiology & Center for the Prevention of Cardiovascular Disease, NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - BingXue Lin
- Department of Medicine, Leon H. Charney Division of Cardiology & Center for the Prevention of Cardiovascular Disease, NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Manish Parikh
- Department of Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Edward A Fisher
- Department of Medicine, Leon H. Charney Division of Cardiology & Center for the Prevention of Cardiovascular Disease, NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Jeffrey S Berger
- Department of Medicine, Leon H. Charney Division of Cardiology & Center for the Prevention of Cardiovascular Disease, NYU Langone Medical Center, NYU School of Medicine, New York, New York; Department of Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Jose O Aleman
- Department of Medicine, Division of Endocrinology, NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Sean P Heffron
- Department of Medicine, Leon H. Charney Division of Cardiology & Center for the Prevention of Cardiovascular Disease, NYU Langone Medical Center, NYU School of Medicine, New York, New York.
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Castillo-Leon E, Connelly MA, Konomi JV, Caltharp S, Cleeton R, Vos MB. Increased atherogenic lipoprotein profile in children with non-alcoholic steatohepatitis. Pediatr Obes 2020; 15:e12648. [PMID: 32367624 DOI: 10.1111/ijpo.12648] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/22/2020] [Accepted: 04/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has been shown to be an independent risk factor for cardiovascular disease. In adults, histologic severity of non-alcoholic steatohepatitis (NASH) is associated with a more atherogenic profile. OBJECTIVE To assess cardiovascular disease risk by lipoprotein profile in children with NAFLD and compare to histologic assessment of severity. METHODS Nuclear magnetic resonance lipoprotein profile including lipoprotein particle sizes, apolipoproteins and the lipoprotein insulin resistance (LP-IR) index was measured in serum samples collected from 76 children at the time of a clinically indicated liver biopsy for NAFLD. Liver histology was scored using the NASH Clinical Research Network criteria and grouped into NASH or non-NASH. RESULTS Children with NASH had higher apolipoprotein B to apolipoprotein AI, ApoB/ApoAI (0.56 [IQR, 0.45-0.70] vs 0.66 [IQR, 0.56-0.79], P = .02) and higher LP-IR index (61 ± 21.9 vs 68 ± 17.3, P = .05) compared to children with non-NASH. Severity of hepatocyte ballooning was associated with higher ApoB/ApoAI ratios (P = .01), while high-density lipoprotein size was inversely associated with hepatic fat accumulation (P = .04). CONCLUSION While dyslipidaemia is common among children with NAFLD, this data suggests severity of the histologic features is closely associated with severity of cardiometabolic risk. Further studies are needed to understand the role of treatment of NASH in children to prevent future cardiometabolic disease.
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Affiliation(s)
- Eduardo Castillo-Leon
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, North Carolina, USA
| | - Juna V Konomi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Shelley Caltharp
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rebecca Cleeton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Miriam B Vos
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA
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A Newly Developed Diabetes Risk Index, Based on Lipoprotein Subfractions and Branched Chain Amino Acids, is Associated with Incident Type 2 Diabetes Mellitus in the PREVEND Cohort. J Clin Med 2020; 9:jcm9092781. [PMID: 32867285 PMCID: PMC7563197 DOI: 10.3390/jcm9092781] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: Evaluate the ability of a newly developed diabetes risk score, the Diabetes Risk Index (DRI), to predict incident type 2 diabetes mellitus (T2D) in a large adult population. Methods: The DRI was developed by combining the Lipoprotein Insulin Resistance Index (LP-IR), calculated from 6 lipoprotein subspecies and size parameters, and the branched chain amino acids, valine and leucine, all of which have been shown previously to be associated with future T2D. DRI scores were calculated in a total of 6134 nondiabetic men and women in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) Study. Cox proportional hazards regression was used to evaluate the association of DRI scores with incident T2D. Results: During a median follow-up of 8.5 years, 306 new T2D cases were ascertained. In analyses adjusted for age and sex, there was a significant association between DRI scores and incident T2D with the hazard ratio (HR) for the highest versus lowest quartile being 12.07 (95% confidence interval: 6.97–20.89, p < 0.001). After additional adjustment for body mass index (BMI), family history of T2D, alcohol consumption, diastolic blood pressure, total cholesterol, triglycerides, HDL cholesterol and HOMA-IR, the HR was attenuated but remained significant (HR 3.20 (1.73–5.95), p = 0.001). Similar results were obtained when DRI was analyzed as HR per 1 SD increase (HR 1.37 (1.14–1.65), p < 0.001). The Kaplan–Meier plot demonstrated that patients in the highest quartile of DRI scores presented at higher risk (p-value for log-rank test <0.001). Conclusions: Higher DRI scores are associated with an increased risk of T2D. The association is independent of clinical risk factors for T2D including HOMA-IR, BMI and conventional lipids.
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Bagheri M, Tiwari HK, Murillo AL, Al-Tobasei R, Arnett DK, Kind T, Barupal DK, Fan S, Fiehn O, O'connell J, Montasser M, Aslibekyan S, Irvin MR. A lipidome-wide association study of the lipoprotein insulin resistance index. Lipids Health Dis 2020; 19:153. [PMID: 32586392 PMCID: PMC7318473 DOI: 10.1186/s12944-020-01321-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background The lipoprotein insulin resistance (LPIR) score was shown to predict insulin resistance (IR) and type 2 diabetes (T2D) in healthy adults. However, the molecular basis underlying the LPIR utility for classification remains unclear. Objective To identify small molecule lipids associated with variation in the LPIR score, a weighted index of lipoproteins measured by nuclear magnetic resonance, in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) study (n = 980). Methods Linear mixed effects models were used to test the association between the LPIR score and 413 lipid species and their principal component analysis-derived groups. Significant associations were tested for replication with homeostatic model assessment-IR (HOMA-IR), a phenotype correlated with the LPIR score (r = 0.48, p < 0.001), in the Heredity and Phenotype Intervention (HAPI) Heart Study (n = 590). Results In GOLDN, 319 lipids were associated with the LPIR score (false discovery rate-adjusted p-values ranging from 4.59 × 10− 161 to 49.50 × 10− 3). Factors 1 (triglycerides and diglycerides/storage lipids) and 3 (mixed lipids) were positively (β = 0.025, p = 4.52 × 10− 71 and β = 0.021, p = 5.84 × 10− 41, respectively) and factor 2 (phospholipids/non-storage lipids) was inversely (β = − 0.013, p = 2.28 × 10− 18) associated with the LPIR score. These findings were replicated for HOMA-IR in the HAPI Heart Study (β = 0.10, p = 1.21 × 10− 02 for storage, β = − 0.13, p = 3.14 × 10− 04 for non-storage, and β = 0.19, p = 8.40 × 10− 07 for mixed lipids). Conclusions Non-storage lipidomics species show a significant inverse association with the LPIR metabolic dysfunction score and present a promising focus for future therapeutic and prevention studies.
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Affiliation(s)
- Minoo Bagheri
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35294, USA.,Department of Cardiovascular Medicine, Vanderbilt University Medical center, Nashville, TN, USA
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anarina L Murillo
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rafet Al-Tobasei
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna K Arnett
- Dean's Office, School of Public Health, University of Kentucky, Lexington, KY, USA
| | - Tobias Kind
- West coast metabolomics center, Davis, CA, USA
| | | | - Sili Fan
- West coast metabolomics center, Davis, CA, USA
| | | | - Jeff O'connell
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - May Montasser
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Stella Aslibekyan
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35294, USA.
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35294, USA
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Adolf C, Berends AMA, Connelly MA, Reincke M, Dullaart RPF. Lipoprotein insulin resistance score and branched-chain amino acids increase after adrenalectomy for unilateral aldosterone-producing adenoma: a preliminary study. Endocrine 2020; 68:420-426. [PMID: 32133607 PMCID: PMC7266834 DOI: 10.1007/s12020-020-02235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/18/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIMS Primary aldosteronism (PA) due to unilateral aldosterone-producing adenoma (APA) is preferentially treated by unilateral adrenalectomy (ADX), but little is known about the changes in lipid and glucose metabolism that may occur after ADX. METHODS We studied 19 non-diabetic patients who did not use lipid-lowering drugs with PA due to APA before and 6 months after unilateral ADX. Fasting plasma lipids, lipoprotein subfractions, branched-chain amino acids (BCAA), and GlycA, a pro-inflammatory glycoprotein biomarker, were measured by nuclear magnetic resonance (NMR) spectroscopy. The Lipoprotein Insulin Resistance (LP-IR) score, which is based on six lipoprotein variables, was calculated. RESULTS In all patients, hyperaldosteronism was resolved after ADX. Body mass index and fasting plasma glucose were unchanged, but HbA1c increased (p = 0.002). Plasma triglycerides, large triglyceride-rich lipoprotein (TRL) cholesterol, and large TRL particles were increased (p < 0.01), resulting in an increase in TRL size (p = 0.027). High-density lipoprotein size was decreased (p = 0.015). LP-IR scores (p = 0.001) and total BCAA (p = 0.017) were increased, but GlycA remained unaltered. CONCLUSIONS Based on increases in LP-IR scores and BCAA, which each have been shown to predict new onset type 2 diabetes mellitus independent of conventional risk factors in the general population, this preliminary study suggests that diabetes risk is not improved but may even be increased after ADX for APA despite remission of PA.
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Affiliation(s)
- Christian Adolf
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, 80336, Munich, Germany
| | - Annika M A Berends
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, USA
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, 80336, Munich, Germany
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Immediate preoperative blood glucose and hemoglobin a1c levels are not predictive of postoperative infections in diabetic men undergoing penile prosthesis placement. Int J Impot Res 2020; 33:296-302. [DOI: 10.1038/s41443-020-0261-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 02/01/2023]
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Garcia E, Shalaurova I, Matyus SP, Oskardmay DN, Otvos JD, Dullaart RP, Connelly MA. Ketone Bodies Are Mildly Elevated in Subjects with Type 2 Diabetes Mellitus and Are Inversely Associated with Insulin Resistance as Measured by the Lipoprotein Insulin Resistance Index. J Clin Med 2020; 9:jcm9020321. [PMID: 31979327 PMCID: PMC7074331 DOI: 10.3390/jcm9020321] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Quantifying mildly elevated ketone bodies is clinically and pathophysiologically relevant, especially in the context of disease states as well as for monitoring of various diets and exercise regimens. As an alternative assay for measuring ketone bodies in the clinical laboratory, a nuclear magnetic resonance (NMR) spectroscopy-based test was developed for quantification of β-hydroxybutyrate (β-HB), acetoacetate (AcAc) and acetone. Methods: The ketone body assay was evaluated for precision, linearity and stability and method comparisons were performed. In addition, plasma ketone bodies were measured in the Insulin Resistance Atherosclerosis Study (IRAS, n = 1198; 373 type 2 diabetes mellitus (T2DM) subjects). Results: β-HB and AcAc quantified using NMR and mass spectrometry and acetone quantified using NMR and gas chromatography/mass spectrometry were highly correlated (R2 = 0.996, 0.994, and 0.994 for β-HB, AcAc, acetone, respectively). Coefficients of variation (%CVs) for intra- and inter-assay precision ranged from 1.3% to 9.3%, 3.1% to 7.7%, and 3.8% to 9.1%, for β-HB, AcAc and acetone, respectively. In the IRAS, ketone bodies were elevated in subjects with T2DM versus non-diabetic individuals (p = 0.011 to ≤0.001). Age- and sex-adjusted multivariable linear regression analysis revealed that total ketone bodies and β-HB were associated directly with free fatty acids (FFAs) and T2DM and inversely with triglycerides and insulin resistance as measured by the Lipoprotein Insulin Resistance Index. Conclusions: Concentrations of the three main ketone bodies can be determined by NMR with good clinical performance, are elevated in T2DM and are inversely associated with triglycerides and insulin resistance.
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Affiliation(s)
- Erwin Garcia
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (I.S.); (S.P.M.); (D.N.O.); (J.D.O.); (M.A.C.)
- Correspondence: ; Tel.: +1-(919)-388-5551
| | - Irina Shalaurova
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (I.S.); (S.P.M.); (D.N.O.); (J.D.O.); (M.A.C.)
| | - Steven P. Matyus
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (I.S.); (S.P.M.); (D.N.O.); (J.D.O.); (M.A.C.)
| | - David N. Oskardmay
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (I.S.); (S.P.M.); (D.N.O.); (J.D.O.); (M.A.C.)
| | - James D. Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (I.S.); (S.P.M.); (D.N.O.); (J.D.O.); (M.A.C.)
| | - Robin P.F. Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Margery A. Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC 27560, USA; (I.S.); (S.P.M.); (D.N.O.); (J.D.O.); (M.A.C.)
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Porter Starr KN, Connelly MA, Orenduff MC, McDonald SR, Sloane R, Huffman KM, Kraus WE, Bales CW. Impact on cardiometabolic risk of a weight loss intervention with higher protein from lean red meat: Combined results of 2 randomized controlled trials in obese middle-aged and older adults. J Clin Lipidol 2019; 13:920-931. [PMID: 31771921 DOI: 10.1016/j.jacl.2019.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/09/2019] [Accepted: 09/26/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The recognized benefits of a higher protein diet on muscle mass and strength in older adults are tempered by concerns of the potentially negative cardiometabolic impact of dietary sources of animal protein. OBJECTIVE The aim of this study was to explore the cardiometabolic impact of 2 weight reduction diets: a higher protein diet, providing balanced portions of lean beef and pork throughout the day, vs. a diet following the Recommended Daily Allowance level of protein in obese middle-aged and older adults. METHODS Data from Measuring Eating, Activity and Strength: Understanding the Response-Using Protein and Protein Optimization in Women Enables Results-Using Protein were combined for the present analysis. Subjects were randomly assigned to a 6-month weight loss diet (500 kcal deficit) and prescribed a Recommended Daily Allowance level of protein (0.8 g protein/kg BW), control group, or a higher level of protein (1.2 g protein/kg BW), protein group. For the protein group, lean, high-quality protein was evenly distributed between meals or balanced throughout the day (30 g protein/meal). The following cardiometabolic markers were quantified by nuclear magnetic resonance spectroscopy: lipids, lipoproteins, GlycA, trimethylamine-N-oxide, betaine, branched-chain amino acids, and lipoprotein insulin resistance index scores. RESULTS In both groups (control [n = 27] and protein [n = 53]), there were significant (P ≤ .05) changes from baseline in weight loss (-6.2% and -7.2%), distance walked (+53.1 and +75.0 meters), and fasting plasma glucose (-7.5 and -6.2 mg/dL), respectively. At endpoint, protein group had significantly (P ≤ .05) lower triglycerides (-17.3 mg/dL), large very-low-density lipoprotein particle concentration (VLDL-P; -1.2 nmol/L), total low-density lipoprotein particle concentration (LDL-P; -67.8 nmol/L), small LDL-P (-59.4 nmol/L) and lipoprotein insulin resistance index (-5.9), whereas control group had significantly (P ≤ .05) lower GlycA (-13.1 μmol/L), total VLDL-P (-7.9 nmol/L), and small VLDL-P (-7.0 nmol/L). Differences between groups were observed for small VLDL-P (P = .02) and protein intake (P < .0001). CONCLUSIONS These findings suggest that a hypocaloric diet with either traditional (0.8 g/kg BW/d) or higher protein (1.2 g/kg BW/d; predominantly from lean red meat) content improves risk markers of cardiovascular disease and type II diabetes in obese middle-aged and older adults. Both diets were also associated with improved physical function, and neither had an adverse impact on cardiometabolic outcomes.
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Affiliation(s)
- Kathryn N Porter Starr
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA.
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, USA
| | - Melissa C Orenduff
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA
| | - Shelley R McDonald
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Richard Sloane
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Kim M Huffman
- Department of Medicine and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Department of Medicine and Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Connie W Bales
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA
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Tuccinardi D, Farr OM, Upadhyay J, Oussaada SM, Klapa MI, Candela M, Rampelli S, Lehoux S, Lázaro I, Sala-Vila A, Brigidi P, Cummings RD, Mantzoros CS. Mechanisms underlying the cardiometabolic protective effect of walnut consumption in obese people: A cross-over, randomized, double-blind, controlled inpatient physiology study. Diabetes Obes Metab 2019; 21:2086-2095. [PMID: 31087608 PMCID: PMC6684390 DOI: 10.1111/dom.13773] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/27/2022]
Abstract
AIMS To assess the effects of walnuts on cardiometabolic outcomes in obese people and to explore the underlying mechanisms using novel methods including metabolomic, lipidomic, glycomic and microbiome analysis, integrated with lipid particle fractionation, appetite-regulating hormones and haemodynamic measurements. MATERIALS AND METHODS A total of 10 obese individuals were enrolled in this cross-over, randomized, double-blind, placebo-controlled clinical trial. The participants had two 5-day inpatient stays, during which they consumed a smoothie containing 48 g walnuts or a macronutrient-matched placebo smoothie without nuts, with a 1-month washout period between the two visits. RESULTS Walnut consumption improved aspects of the lipid profile; it reduced fasting small and dense LDL particles (P < 0.02) and increased postprandial large HDL particles (P < 0.01). Lipoprotein insulin resistance score, glucose and the insulin area under the curve (AUC) decreased significantly after walnut consumption (P < 0.01, P < 0.02 and P < 0.04, respectively). Consuming walnuts significantly increased 10 N-glycans, with eight of them carrying a fucose core. Lipidomic analysis showed a robust reduction in harmful ceramides, hexosylceramides and sphingomyelins, which have been shown to mediate effects on cardiometabolic risk. The peptide YY AUC significantly increased after walnut consumption (P < 0.03). No major significant changes in haemodynamic or metabolomic analysis or in microbiome host health-promoting bacteria such as Faecalibacterium were found. CONCLUSIONS These data provide a more comprehensive mechanistic perspective of the effect of dietary walnut consumption on cardiometabolic variables. Lipidomic and lipid nuclear magnetic resonance spectroscopy analysis showed an early but significant reduction in ceramides and other atherogenic lipids with walnut consumption, which may explain the longer-term benefits of walnuts or other nuts on insulin resistance, cardiovascular risk and mortality.
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Affiliation(s)
- Dario Tuccinardi
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Centre/Harvard Medical School, Boston, Massachusetts
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Olivia M Farr
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Centre/Harvard Medical School, Boston, Massachusetts
| | - Jagriti Upadhyay
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Centre/Harvard Medical School, Boston, Massachusetts
| | - Sabrina M Oussaada
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Centre/Harvard Medical School, Boston, Massachusetts
| | - Maria I Klapa
- Department of Chemical & Biomolecular Engineering & Bioengineering, Metabolic Engineering and Systems Biology Laboratory, Institute of Chemical Engineering Sciences, Foundation for Research and Technology-Hellas, Patras, Greece
| | - Marco Candela
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Simone Rampelli
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Sylvain Lehoux
- Department of Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Beth Israel Deaconess Medical Centre Glycomics Core, Boston, Massachusetts
| | - Iolanda Lázaro
- CIBERde Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomediques August PiSunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Aleix Sala-Vila
- CIBERde Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomediques August PiSunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Patrizia Brigidi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Richard D Cummings
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Christos S Mantzoros
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Centre/Harvard Medical School, Boston, Massachusetts
- Section of Endocrinology, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
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Tobias DK, Lawler PR, Harada PH, Demler OV, Ridker PM, Manson JE, Cheng S, Mora S. Circulating Branched-Chain Amino Acids and Incident Cardiovascular Disease in a Prospective Cohort of US Women. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e002157. [PMID: 29572205 DOI: 10.1161/circgen.118.002157] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Circulating branched-chain amino acids (BCAAs; isoleucine, leucine, and valine) are strong predictors of type 2 diabetes mellitus (T2D), but their association with cardiovascular disease (CVD) is uncertain. We hypothesized that plasma BCAAs are positively associated with CVD risk and evaluated whether this was dependent on an intermediate diagnosis of T2D. METHODS Participants in the Women's Health Study prospective cohort were eligible if free of CVD at baseline blood collection (n=27 041). Plasma metabolites were measured via nuclear magnetic resonance spectroscopy. Multivariable Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for BCAAs with incident CVD (myocardial infarction, stroke, and coronary revascularization). RESULTS We confirmed 2207 CVD events over a mean 18.6 years of follow-up. Adjusting for age, body mass index, and other established CVD risk factors, total BCAAs were positively associated with CVD (per SD: HR, 1.13; 95% CI, 1.08-1.18), comparable to LDL-C (low-density lipoprotein cholesterol) with CVD (per SD: HR, 1.12; 95% CI, 1.07-1.17). BCAAs were associated with coronary events (myocardial infarction: HR, 1.16; 95% CI, 1.06-1.26; revascularization: HR, 1.17; 95% CI, 1.11-1.25), and borderline significant association with stroke (HR, 1.07; 95% CI, 0.99-1.15). The BCAA-CVD association was greater (P interaction=0.036) among women who developed T2D before CVD (HR, 1.20; 95% CI, 1.08-1.32) versus women without T2D (HR, 1.08; 95% CI, 1.03-1.14). Adjusting for LDL-C, an established CVD risk factor, did not attenuate these findings; however, adjusting for HbA1c and insulin resistance eliminated the associations of BCAAs with CVD. CONCLUSIONS Circulating plasma BCAAs were positively associated with incident CVD in women. Impaired BCAA metabolism may capture the long-term risk of the common cause underlying T2D and CVD.
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Affiliation(s)
- Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Patrick R Lawler
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Paulo H Harada
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Olga V Demler
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Paul M Ridker
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Susan Cheng
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Samia Mora
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
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Affiliation(s)
- Zachary Bloomgarden
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Chilton
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
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Non-alcoholic fatty liver disease presence and severity are associated with aortic stiffness beyond abdominal obesity: The ELSA-Brasil. Atherosclerosis 2019; 284:59-65. [PMID: 30875494 DOI: 10.1016/j.atherosclerosis.2019.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/27/2018] [Accepted: 02/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS It is uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with aortic stiffness in a racial/ethnically diverse and admixed society. We addressed whether NAFLD presence and severity were associated with carotid-femoral pulse wave velocity (cf-PWV) in individuals free of cardiovascular disease. METHODS In 7196 individuals free of cardiovascular disease at the baseline Brazilian longitudinal study of adult health, we classified NAFLD presence and severity (mild, moderate and severe) by ultrasound hepatic attenuation. We measured cf-PWV using a non-invasive validated device (Complior SP, Artech Medicale France). We compared cf-PWV of NAFLD individuals to those without by analysis of covariance adjusted for demographics, life style, waist circumference, and arterial pressure. We also analyzed the cf-PWV trend from no-NAFLD to severe NAFLD. RESULTS In unadjusted analysis, from no-NAFLD to severe NAFLD, there were slightly older individuals, lower frequency of smokers, more prevalent diabetes and hypertension. In adjusted analysis, there was slightly higher cf-PWV (m/s) (95%CI) in NAFLD vs. no-NAFLD, respectively 9.32 (9.22, 9.41) and 9.24 (9.15, 9.33) (p = 0.037). Across NAFLD severity spectrum, adjusted cf-PWV increased from 9.24 (9.15, 9.33) in no-NAFLD to 9.69 (9.46, 9.93) in severe NAFLD (p for trend association = 0.001). In sensitivity analysis, diabetes adjustment nullified the association of binary NAFLD with cf-PWV, but not that of increasingly severe NAFLD. CONCLUSIONS In racial/ethnically diverse individuals free of cardiovascular disease, NAFLD is associated with aortic stiffness beyond abdominal obesity. The specific NAFLD impact on CVD worldwide is potentially relevant.
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Flores-Guerrero JL, Connelly MA, Shalaurova I, Gruppen EG, Kieneker LM, Dullaart RPF, Bakker SJL. Lipoprotein insulin resistance index, a high-throughput measure of insulin resistance, is associated with incident type II diabetes mellitus in the Prevention of Renal and Vascular End-Stage Disease study. J Clin Lipidol 2018; 13:129-137.e1. [PMID: 30591414 DOI: 10.1016/j.jacl.2018.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early assessment of insulin resistance may be a way of identifying patients at risk as well as monitoring treatments that increase insulin sensitivity and reduce the risk of developing type II diabetes mellitus (T2DM). OBJECTIVE The objective of the study was to evaluate the ability of the Lipoprotein Insulin Resistance Index (LP-IR) to predict incident T2DM in a large cohort. METHODS LP-IR scores were calculated using 6 lipoprotein particle concentrations and sizes measured by nuclear magnetic resonance spectroscopy. In total, 5977 nondiabetic men and women were included. Cox proportional hazards regression was used to evaluate the association of LP-IR scores with incident T2DM. RESULTS LP-IR scores were closely associated with insulin resistance, assessed by homeostatic model assessment of insulin resistance (r = 0.51; P < .0001). During a median follow-up for 7.5 years, 278 new T2DM cases were ascertained. The Kaplan-Meier plot with log-rank test (P < .001) demonstrated that elevated LP-IR levels are associated with an increased T2DM risk. In analyses adjusted for age and sex, LP-IR was associated with incident T2DM; hazard ratio (HR) for the highest versus lowest quartile was 10.18 (95% confidence interval: 6.24-16.61), P < .0001. After adjustment for clinical risk factors, the HR was attenuated but remained significant (HR 3.02 [1.73-5.25], P < .0001). LP-IR scores added significantly to the performance of the Framingham Offspring prediction algorithm; C-index (95% confidence interval) for the Framingham Offspring score without and with LP-IR (0.863 [0.863-0.864] and 0.868 [0.867-0.86], P < .0001). Similar results were observed when LP-IR was analyzed as a categorical variable with a clinical cut-point of 68. CONCLUSION LP-IR may be a convenient way to assess insulin resistance and T2DM risk, as well as to monitor preventative treatments.
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Affiliation(s)
- Jose L Flores-Guerrero
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, USA
| | - Irina Shalaurova
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, USA
| | - Eke G Gruppen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lyanne M Kieneker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Danford CJ, Connelly MA, Shalaurova I, Kim M, Herman MA, Nasser I, Otvos JD, Afdhal NH, Jiang ZG, Lai M. A Pathophysiologic Approach Combining Genetics and Insulin Resistance to Predict the Severity of Nonalcoholic Fatty Liver Disease. Hepatol Commun 2018; 2:1467-1478. [PMID: 30556036 PMCID: PMC6287585 DOI: 10.1002/hep4.1267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/07/2018] [Indexed: 12/26/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a complex disease dictated by both genetic and environmental factors. While insulin resistance (IR) is a key pathogenic driver, two common genetic variants in patatin‐like phospholipase domain containing 3 (PNPLA3) and transmembrane 6 superfamily member 2 (TM6SF2) also impart significant risk for disease progression. Traditional approaches to NAFLD risk stratification rely on biomarkers of fibrosis, an end result of disease progression. We hypothesized that by combining genetics and a novel measurement for IR we could predict disease progression by the NAFLD activity score (NAS) and histologic presence of significant fibrosis. A total of 177 patients with biopsy‐proven NAFLD were enrolled in this cross‐sectional study. PNPLA3 I148M and TM6SF2 E167K genotypes were determined by TaqMan assays. The enhanced lipoprotein IR index (eLP‐IR) was calculated from serum biomarkers using nuclear magnetic resonance (NMR) spectroscopy. Multivariate regression models were used to study the relationships between genetics, IR, and histologic features of NAFLD. In the multivariate analysis, the eLP‐IR was strongly associated with histologic features of NAFLD activity and hepatic fibrosis (P < 0.001 to 0.02) after adjustment for potential confounders. PNPLA3 148M and TM6SF2 E167K genotypes were significantly associated with steatosis (P = 0.003 and P = 0.02, respectively). A combination of the eLP‐IR and genetic score was able to predict the presence of NAS ≥3 with an area under the receiver operating characteristic curve (AUROC) of 0.74. Adding age to this model predicted stages 3‐4 liver fibrosis with an AUROC of 0.82. Conclusion: This proof‐of‐concept study supports the hypothesis that genetics and IR are major determinants of NAFLD severity and demonstrates the feasibility of a new risk stratification paradigm using exclusively pathogenic factors.
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Affiliation(s)
- Christopher J Danford
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA
| | | | - Irina Shalaurova
- Laboratory Corporation of America Holdings (LabCorp) Morrisville NC
| | - Misung Kim
- Division of Endocrinology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA
| | - Mark A Herman
- Division of Endocrinology Duke University Medical Center Durham NC
| | - Imad Nasser
- Department of Pathology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp) Morrisville NC
| | - Nezam H Afdhal
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA
| | - Z Gordon Jiang
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA
| | - Michelle Lai
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA
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Creighton BC, Hyde PN, Maresh CM, Kraemer WJ, Phinney SD, Volek JS. Paradox of hypercholesterolaemia in highly trained, keto-adapted athletes. BMJ Open Sport Exerc Med 2018; 4:e000429. [PMID: 30305928 PMCID: PMC6173254 DOI: 10.1136/bmjsem-2018-000429] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 12/24/2022] Open
Abstract
Objective A growing number of ultra-endurance athletes have switched to a very low-carbohydrate/high-fat eating pattern. We compared markers of cholesterol and the lipoprotein profile in a group of elite ultra-runners consuming a high-carbohydrate (HC) or low-carbohydrate (LC) diet. Methods Fasting blood was obtained from competitive male ultra-endurance runners habitually consuming a very low-carbohydrate (LC; n=10) or high-carbohydrate (HC; n=10) diet to determine blood cholesterol profile, lipoprotein particle distribution and sterol biomarkers of cholesterol balance. Results Plasma total cholesterol, low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) cholesterol were all significantly greater (p<0.000) in the LC group (65%, 83% and 60%, respectively). There were also significant differences in lipoprotein particle distribution as evidenced by a greater size and concentration of large HDL and LDL particles, and total LDL particle concentration was significantly greater in the LC group, but they had significantly fewer small LDL particles. Conclusion Ultra-endurance athletes habitually consuming a very low-carbohydrate/high-fat diet for over a year showed unique cholesterol profiles characterised by consistently higher plasma LDL-C and HDL-C, less small LDL particles, and lipoprotein profiles consistent with higher insulin sensitivity. There may be a functional purpose to the expansion of the circulating cholesterol pool to meet the heightened demand for lipid transport in highly trained, keto-adapted athletes.
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Affiliation(s)
| | - Parker Neil Hyde
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Carl M Maresh
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| | | | - Jeff S Volek
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
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