1
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Szablewski L. Insulin Resistance: The Increased Risk of Cancers. Curr Oncol 2024; 31:998-1027. [PMID: 38392069 PMCID: PMC10888119 DOI: 10.3390/curroncol31020075] [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: 11/24/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Insulin resistance, also known as impaired insulin sensitivity, is the result of a decreased reaction of insulin signaling to blood glucose levels. This state is observed when muscle cells, adipose tissue, and liver cells, improperly respond to a particular concentration of insulin. Insulin resistance and related increased plasma insulin levels (hyperinsulinemia) may cause metabolic impairments, which are pathological states observed in obesity and type 2 diabetes mellitus. Observations of cancer patients confirm that hyperinsulinemia is a major factor influencing obesity, type 2 diabetes, and cancer. Obesity and diabetes have been reported as risks of the initiation, progression, and metastasis of several cancers. However, both of the aforementioned pathologies may independently and additionally increase the cancer risk. The state of metabolic disorders observed in cancer patients is associated with poor outcomes of cancer treatment. For example, patients suffering from metabolic disorders have higher cancer recurrence rates and their overall survival is reduced. In these associations between insulin resistance and cancer risk, an overview of the various pathogenic mechanisms that play a role in the development of cancer is discussed.
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Affiliation(s)
- Leszek Szablewski
- Chair and Department of General Biology and Parasitology, Medical University of Warsaw, Chałubińskiego 5 Str., 02-004 Warsaw, Poland
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2
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Qi R, Yang Y, Sheng B, Li H, Zhang X. Plant-Based Diet Indices and Their Association with Frailty in Older Adults: A CLHLS-Based Cohort Study. Nutrients 2023; 15:5120. [PMID: 38140379 PMCID: PMC10745508 DOI: 10.3390/nu15245120] [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: 11/17/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Within the realm of aging, the nexus between diet and health has garnered considerable attention. However, only select studies have amalgamated insights into the correlation between plant and animal food consumption and frailty. Our aim was to appraise the connections between the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) and frailty in the elderly, utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). This cohort study drew upon CLHLS data spanning from 2008 to 2018. The PDI, hPDI, and uPDI were gauged using a simplified food frequency questionnaire (FFQ). A frailty index, encompassing 35 variables across major health domains, was formulated. Cox proportional hazard models were employed to scrutinize the associations between the three plant-based dietary indices and frailty in older adults, including an exploration of gender disparities in these associations. A cohort of 2883 study participants was encompassed, with 1987 (68.9%) observed to be either frail or in the pre-frail stage. The Cox model with penalized spline exhibited linear associations of PDI, hPDI, and uPDI with the frailty index. Following covariate adjustments, it was discerned that older adults situated in the highest quartiles of PDI (HR = 0.86, 95% CI: 0.77-0.95) and hPDI (HR = 0.83, 95% CI: 0.74-0.93) experienced a 14% and 17% diminished risk of frailty compared to those in the lowest quartiles of PDI and hPDI, respectively. Conversely, when contrasted with those in the lowest quartile of uPDI, older adults adhering to the highest tertile of uPDI exhibited a 21% elevated risk of frailty (HR = 1.21, 95% CI: 1.08-1.36), with both associations achieving statistical significance (p < 0.01). Moreover, additional subgroup analyses revealed that the protective effects of PDI and hPDI against frailty and the deleterious effects of uPDI were more conspicuous in men compared to women. To forestall or decelerate the progression of frailty in the elderly, tailored dietary interventions are imperative, particularly targeting male seniors.
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Affiliation(s)
| | | | | | | | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China; (R.Q.); (Y.Y.); (B.S.); (H.L.)
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3
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Kolb H, Kempf K, Martin S. Insulin and aging - a disappointing relationship. Front Endocrinol (Lausanne) 2023; 14:1261298. [PMID: 37854186 PMCID: PMC10579801 DOI: 10.3389/fendo.2023.1261298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/25/2023] [Indexed: 10/20/2023] Open
Abstract
Experimental studies in animal models of aging such as nematodes, fruit flies or mice have observed that decreased levels of insulin or insulin signaling promotes longevity. In humans, hyperinsulinemia and concomitant insulin resistance are associated with an elevated risk of age-related diseases suggestive of a shortened healthspan. Age-related disorders include neurodegenerative diseases, hypertension, cardiovascular disease, and type 2 diabetes. High ambient insulin concentrations promote increased lipogenesis and fat storage, heightened protein synthesis and accumulation of non-functional polypeptides due to limited turnover capacity. Moreover, there is impaired autophagy activity, and less endothelial NO synthase activity. These changes are associated with mitochondrial dysfunction and oxidative stress. The cellular stress induced by anabolic activity of insulin initiates an adaptive response aiming at maintaining homeostasis, characterized by activation of the transcription factor Nrf2, of AMP activated kinase, and an unfolded protein response. This protective response is more potent in the long-lived human species than in short-lived models of aging research resulting in a stronger pro-aging impact of insulin in nematodes and fruit flies. In humans, resistance to insulin-induced cell stress decreases with age, because of an increase of insulin and insulin resistance levels but less Nrf2 activation. These detrimental changes might be contained by adopting a lifestyle that promotes low insulin/insulin resistance levels and enhances an adaptive response to cellular stress, as observed with dietary restriction or exercise.
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Affiliation(s)
- Hubert Kolb
- Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
| | - Kerstin Kempf
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
| | - Stephan Martin
- Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany
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4
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Parajuli S, Odorico J, Breyer I, Zona E, Aziz F, Lorden H, Garonzik-Wang J, Kaufman D, Mandelbrot D. Analysis of Individual Components of Frailty in Simultaneous Pancreas and Kidney, and Solitary Pancreas Transplant Recipients. Transplant Direct 2023; 9:e1523. [PMID: 37649788 PMCID: PMC10465099 DOI: 10.1097/txd.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 09/01/2023] Open
Abstract
Backgrounds It is not known which of the 5 components of the Fried frailty score have the most predictive value for outcomes in simultaneous pancreas-kidney transplant (SPK) and solitary pancreas transplant (SPT) recipients. Methods In this study, we sought to investigate the association between pretransplant overall frailty and individual frailty components, with posttransplant outcomes among SPK and SPT recipients. Outcomes of interest were length of stay, kidney delayed graft function (K-DGF), readmission within 30 d after discharge, cardiovascular events, acute rejection, pancreas death-censored graft failure (DCGF), kidney DCGF, and death. Results Of the individual frailty components among SPK (n = 113), only slow walk time was associated with an increased risk of mortality (adjusted odds ratio [aOR]: 4.99; P = 0.03). Among SPT (n = 49), higher sum frailty scores (coefficient correlation 0.29; P = 0.04) and weight loss (coefficient correlation = 0.30; P = 0.03) were associated with prolonged length of stay. Similarly, weight loss among SPT was associated with an increased risk of DCGF (aOR: 4.34; P = 0.049). Low grip strength was strongly associated with an increased risk of early readmission (aOR: 13.08; P = 0.008). Conclusions We found that not all components of frailty contribute equally to predicting outcomes. Objective measurements of slow walk time, unintentional weight loss, and low grip strength were found to be associated with less optimal outcomes in pancreas transplant recipients. Targeted interventions may improve posttransplant outcomes.
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Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- UW Health Transplant Center
| | - Jon Odorico
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Isabel Breyer
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Emily Zona
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- UW Health Transplant Center
| | - Heather Lorden
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jacqueline Garonzik-Wang
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dixon Kaufman
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- UW Health Transplant Center
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Hedges CP, Shetty B, Broome SC, MacRae C, Koutsifeli P, Buckels EJ, MacIndoe C, Boix J, Tsiloulis T, Matthews BG, Sinha S, Arendse M, Jaiswal JK, Mellor KM, Hickey AJR, Shepherd PR, Merry TL. Dietary supplementation of clinically utilized PI3K p110α inhibitor extends the lifespan of male and female mice. NATURE AGING 2023; 3:162-172. [PMID: 37118113 DOI: 10.1038/s43587-022-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/02/2022] [Indexed: 04/30/2023]
Abstract
Diminished insulin and insulin-like growth factor-1 signaling extends the lifespan of invertebrates1-4; however, whether it is a feasible longevity target in mammals is less clear5-12. Clinically utilized therapeutics that target this pathway, such as small-molecule inhibitors of phosphoinositide 3-kinase p110α (PI3Ki), provide a translatable approach to studying the impact of these pathways on aging. Here, we provide evidence that dietary supplementation with the PI3Ki alpelisib from middle age extends the median and maximal lifespan of mice, an effect that was more pronounced in females. While long-term PI3Ki treatment was well tolerated and led to greater strength and balance, negative impacts on common human aging markers, including reductions in bone mass and mild hyperglycemia, were also evident. These results suggest that while pharmacological suppression of insulin receptor (IR)/insulin-like growth factor receptor (IGFR) targets could represent a promising approach to delaying some aspects of aging, caution should be taken in translation to humans.
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Affiliation(s)
- C P Hedges
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
| | - B Shetty
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - S C Broome
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - C MacRae
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - P Koutsifeli
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - E J Buckels
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - C MacIndoe
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - J Boix
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - T Tsiloulis
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - B G Matthews
- Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - S Sinha
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand
| | - M Arendse
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand
| | - J K Jaiswal
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Auckland Cancer Society Research Centre, University of Auckland, Auckland, New Zealand
| | - K M Mellor
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - A J R Hickey
- Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - P R Shepherd
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Molecular Medicine and Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - T L Merry
- Discipline of Nutrition, School of Medical Sciences, University of Auckland, Auckland, New Zealand.
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand.
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6
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Zhao X, An X, Yang C, Sun W, Ji H, Lian F. The crucial role and mechanism of insulin resistance in metabolic disease. Front Endocrinol (Lausanne) 2023; 14:1149239. [PMID: 37056675 PMCID: PMC10086443 DOI: 10.3389/fendo.2023.1149239] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Insulin resistance (IR) plays a crucial role in the development and progression of metabolism-related diseases such as diabetes, hypertension, tumors, and nonalcoholic fatty liver disease, and provides the basis for a common understanding of these chronic diseases. In this study, we provide a systematic review of the causes, mechanisms, and treatments of IR. The pathogenesis of IR depends on genetics, obesity, age, disease, and drug effects. Mechanistically, any factor leading to abnormalities in the insulin signaling pathway leads to the development of IR in the host, including insulin receptor abnormalities, disturbances in the internal environment (regarding inflammation, hypoxia, lipotoxicity, and immunity), metabolic function of the liver and organelles, and other abnormalities. The available therapeutic strategies for IR are mainly exercise and dietary habit improvement, and chemotherapy based on biguanides and glucagon-like peptide-1, and traditional Chinese medicine treatments (e.g., herbs and acupuncture) can also be helpful. Based on the current understanding of IR mechanisms, there are still some vacancies to follow up and consider, and there is also a need to define more precise biomarkers for different chronic diseases and lifestyle interventions, and to explore natural or synthetic drugs targeting IR treatment. This could enable the treatment of patients with multiple combined metabolic diseases, with the aim of treating the disease holistically to reduce healthcare expenditures and to improve the quality of life of patients to some extent.
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Affiliation(s)
| | | | | | | | - Hangyu Ji
- *Correspondence: Fengmei Lian, ; Hangyu Ji,
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Ji SH, Dong C, Chen R, Shen CC, Xiao J, Gu YJ, Gao JL. Effects of Variability in Glycemic Indices on Longevity in Chinese Centenarians. Front Nutr 2022; 9:955101. [PMID: 35879983 PMCID: PMC9307500 DOI: 10.3389/fnut.2022.955101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 12/11/2022] Open
Abstract
Background Large fluctuations in blood glucose levels greatly impact the health and life span of elderly individuals. This study describes the characteristics of variability in glycemic indices in centenarians with the aim of emphasizing the importance of glycemic variability in elderly people. Methods We recruited individuals from Rugao City, Jiangsu Province, China from April 2020 to May 2021. The study cohort included 60 centenarians and 60 first-generation offspring, as well as 20 randomly selected non-cohabitant control individuals aged 60–80 years. A FreeStyle Libre H (hospital version) continuous glucose monitoring (CGM) device (Abbott Ireland UK) was used to measure glycemic variability. The indices measured included the time in target glucose range (TIR), time below target glucose range (TBR), time above target glucose range (TAR), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), coefficient of variation (CV), standard deviation of blood glucose (SDBG), continuous overlapping net glycemic action (CONGA), glucose management indicator (GMI) and estimated glycated hemoglobin (eHbA1c). Logistic regression was used to analyze the association between glycemic variability and longevity. Results Mean blood glucose (MBG), eHbA1c, GMI, mean fasting plasma glucose (M-FPG) and CONGA were lower in the centenarian group (p all < 0.05). PPGE-2 was higher in the control group than that measured in the centenarian and first-generation offspring groups (p < 0.05). There were no differences between the groups in MAGE, MODD, MAG, or TIR (p > 0.05). The risk of not achieving longevity increased with each one unit increase in MBG by 126% [2.26 (1.05–4.91)], eHbA1c by 67% [1.67 (1.03–2.72)], GMI by 568% [6.68 (1.11–40.30)], M-FPG by 365% [4.65 (1.57–13.75)], M-PPG1h by 98% [1.98 (1.18–3.31)], CONGA1 by 102% [2.02 (1.01–4.06)], Li by 200% [3.00 (1.04–8.61)], and PPGE-2 by 150% [2.50 (1.39–4.50)]. However, the risk of achieving longevity decreased with each unit increase of LBGI by 53% [0.47 (0.28–0.80)], ADRR by 60% [0.40 (0.18–0.86)], and TBR by 11% [0.89 (0.80–0.98)]. Conclusion Fluctuation in blood glucose levels in centenarians is relatively small. Maintaining an average blood glucose level and keeping blood glucose fluctuations in the normal range is conducive to longevity.
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Affiliation(s)
- Sheng-han Ji
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
- Medical School of Nantong University, Nantong University, Nantong, China
| | - Chen Dong
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
| | - Rou Chen
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
- Medical School of Nantong University, Nantong University, Nantong, China
| | - Chen-chen Shen
- Department of Cardiology, Rugao Bo'ai Branch of Nantong University Affiliated Hospital, Nantong, China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Yun-juan Gu
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
- Department of Health Medicine, Affiliated Hospital of Nantong University, Nantong, China
- *Correspondence: Yun-juan Gu
| | - Jian-lin Gao
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China
- Jian-lin Gao
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8
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Hossain MB, Khan MN, Oldroyd JC, Rana J, Magliago DJ, Chowdhury EK, Karim MN, Islam RM. Prevalence of, and risk factors for, diabetes and prediabetes in Bangladesh: Evidence from the national survey using a multilevel Poisson regression model with a robust variance. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000461. [PMID: 36962350 PMCID: PMC10021925 DOI: 10.1371/journal.pgph.0000461] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/18/2022] [Indexed: 12/25/2022]
Abstract
To estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels. Data from 11952 Bangladeshi adults aged 18-95 years available from the most recent Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardized with direct standardization, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. The overall age-standardised prevalence of diabetes was 9.2% (95%CI 8.7-9.7) (men: 8.8%, women: 9.6%), and prediabetes was 13.3% (95%CI 12.7-13.9) (men: 13.0%, women: 13.6%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% took treatment regularly, and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile, and living in the Dhaka division. People currently employed and living in the Rangpur division were less likely to have diabetes than those currently not employed and living in the Barishal division. Diabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, focusing on obesity reduction and hypertension management, are urgently needed.
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Affiliation(s)
| | - Md. Nuruzzaman Khan
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - John C. Oldroyd
- School of Behavioral and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Juwel Rana
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
| | - Dianna J. Magliago
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Enayet K. Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Md Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rakibul M. Islam
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ma XY, Chen FQ. Effects of anti-diabetic drugs on sarcopenia: Best treatment options for elderly patients with type 2 diabetes mellitus and sarcopenia. World J Clin Cases 2021; 9:10064-10074. [PMID: 34904076 PMCID: PMC8638038 DOI: 10.12998/wjcc.v9.i33.10064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/22/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
Human life expectancy increases as society becomes more developed. This increased life expectancy poses challenges associated with the rapid aging of the population. Sarcopenia, an age-related disease, has become a worldwide health issue. Patients with sarcopenia experience decreases in muscle mass and function, becoming frail and eventually bedridden. Type 2 diabetes mellitus (T2DM) is also a major health issue; the incidence of T2DM increases with aging. T2DM is associated with reduced muscle strength and poor muscle quality and may contribute to acceleration of the aging process, augmenting age-related sarcopenia. Recent studies indicate that elderly patients with diabetes are at an increased risk for sarcopenia. Therefore, these older diabetic patients with sarcopenia need specific anti-diabetic therapies targeting not only glycemic control but also sarcopenia, with the goal of preventing sarcopenia in pre-sarcopenic patients. Presently, various types of hypoglycemic drugs are available, but which hypoglycemic drugs are better suited for geriatric T2DM patients with sarcopenia remains undetermined. In this review, we discuss the association between diabetes and sarcopenia in geriatric patients, and how anti-diabetic drugs may influence sarcopenia outcomes. This review will guide clinical workers in the selection of drugs best suited for this patient population.
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Affiliation(s)
- Xiao-Yu Ma
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fen-Qin Chen
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
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10
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Binkley HM, Phillips KL, Wise SL. Menopausal Women: Recognition, Exercise Benefits, Considerations, and Programming Needs. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chao HH, Liao YH, Chou CC. Influences of Recreational Tennis-Playing Exercise Time on Cardiometabolic Health Parameters in Healthy Elderly: The ExAMIN AGE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031255. [PMID: 33573269 PMCID: PMC7908508 DOI: 10.3390/ijerph18031255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Aging and chronic degeneration are the primary threats to cardiometabolic health in elderly populations. Regular appropriate exercise would benefit the advanced aging population. PURPOSE This study investigates whether the degree of weekly tennis participation exhibits differences in primary cardiometabolic parameters, including arterial stiffness, inflammation, and metabolic biomarkers in elderly tennis players. METHODS One hundred thirty-five long-term participants in elder tennis (>50 years old) were initially screened. Twenty-six eligible and voluntary subjects were divided into high tennis time group (HT) (14 ± 1.3 h/week) and low tennis time group (LT) (4.5 ± 0.7 h/week) by stratification analysis based on the amount of tennis playing activity time. The brachial-ankle pulse wave velocity (baPWV), blood pressure, ankle-brachial index (ABI), blood metabolic biomarkers, and insulin resistance were measured to compare the difference between HT and LT groups. RESULTS The baPWV was significantly lower in the HT group than that in the LT group (1283.92 ± 37.01 vs. 1403.69 ± 53.71 cm/s, p < 0.05). We also found that the HT insulin-resistant homeostasis model assessment (HOMA-IR) was significantly lower than that of LT (1.41 ± 0.11 vs. 2.27 ± 0.48 μIU/mL, p < 0.05). However, the blood lipid biomarkers (glucose, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride) were not statistical different between HT and LT groups (p > 0.05). CONCLUSION We demonstrated that under the condition of similar daily physical activity level, elderly with a higher time of tennis-playing (HT group) exhibited relatively lower arterial stiffness (lower PWV) and lower insulin resistance compared to those with lower time tennis-playing (LT).
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Affiliation(s)
- Hsiao-Han Chao
- Department of Athletics, National Taiwan University, Taipei 10617, Taiwan;
| | - Yi-Hung Liao
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
| | - Chun-Chung Chou
- Physical Education Office, National Taipei University of Technology, Taipei 10608, Taiwan
- Correspondence: ; Tel.: +886-2-27712171 (ext. 3332)
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12
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Torabi J, Rocca JP, Kestenbaum E, Ajaimy M, DeFeo M, Konicki A, Liriano-Ward L, Azzi Y, Pynadath C, Akalin E, Kinkhabwala M, Graham JA. Preoperative C-Peptide Predicts Weight Gain After Pancreas Transplantation. Prog Transplant 2020; 30:117-124. [PMID: 32242484 DOI: 10.1177/1526924820913518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transplant recipients are susceptible to cardiovascular complications, obesity, and increased insulin resistance after transplant. Here we assess weight gain in diabetic recipients after pancreas transplantation. METHODS This is a single-center study of 32 simultaneous pancreas and kidney and 5 pancreas after kidney transplant recipients from 2014 to 2018. Starting C-peptide levels ≤ 0.1 ng/mL were used to denote insulin nondetectability (n = 25) and C-peptide levels > 0.1 ng/mL as insulin detectability (n = 12). Hemoglobin A1c, body mass index (BMI), and weight following transplantation were assessed. RESULTS Hemoglobin A1c at 1 year was 5.9% in the insulin nondetectable recipients and 5.6% in the insulin detectable group (P = .56). Average BMI after transplant was higher in the insulin detectable group 28.6 versus 24.4 kg/m2 (P = .03) despite no difference in starting BMIs (24.9 versus 24.0 kg/m2, P = .42). The insulin detectable group also had a larger percentage weight change from their starting weight 13.1% versus 0.9 % at 1 year (P = .02). Linear regression demonstrated that starting C-peptide was a significant predictor of weight gain posttransplant. CONCLUSIONS Patients with elevated C-peptides at time of transplant are susceptible to rapid weight gain postoperatively. These patients may benefit from aggressive nutritional management.
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Affiliation(s)
- Julia Torabi
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Juan P Rocca
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Elizabeth Kestenbaum
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Maria Ajaimy
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Monica DeFeo
- Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Athena Konicki
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Luz Liriano-Ward
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Yorg Azzi
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Cindy Pynadath
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Enver Akalin
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Milan Kinkhabwala
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Jay A Graham
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
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13
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Yoon SJ, Kim KI. Frailty and Disability in Diabetes. Ann Geriatr Med Res 2019; 23:165-169. [PMID: 32743307 PMCID: PMC7370756 DOI: 10.4235/agmr.19.0036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 12/25/2022] Open
Abstract
Diabetes is an important health problem with the population aging. Previously, it is well established that diabetes is associated with microvascular and macrovascular complications, but recently, several data suggest that diabetes is accompanied with frailty as well as disability among the older adults. Considering the clinical significance of frailty and disability, it is important to understand the pathway from diabetes to frailty and/or disability. Additionally, it is strongly recommended to find a new therapeutic intervention are required to meet the increasing demand of managing older diabetic patients with the population aging.
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Affiliation(s)
- Sol-Ji Yoon
- Departement of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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14
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Someya Y, Tamura Y, Kaga H, Nojiri S, Shimada K, Daida H, Ishijima M, Kaneko K, Aoki S, Miida T, Hirayama S, Konishi S, Hattori N, Motoi Y, Naito H, Kawamori R, Watada H. Skeletal muscle function and need for long-term care of urban elderly people in Japan (the Bunkyo Health Study): a prospective cohort study. BMJ Open 2019; 9:e031584. [PMID: 31530621 PMCID: PMC6756356 DOI: 10.1136/bmjopen-2019-031584] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The proportion of elderly individuals (age ≥65 years) in Japan reached 27.7% in 2017, the highest in the world. A serious social problem in a super-aged society is the rise in the number of elderly people who need long-term care (LTC), which is mainly due to cerebrovascular disease, dementia, age-related frailty, falls and fractures, and joint disease. We hypothesised that decreased muscle mass, muscle strength and insulin sensitivity are the common risk factors for these diseases related to needing LTC. We developed a prospective cohort study of elderly subjects in an urban community to test this hypothesis. The primary objective is to prospectively investigate associations between muscle mass, muscle strength, and insulin sensitivity and incidence of main disease and risk factors of needing LTC. The primary outcomes are the incidence of cerebrovascular disease and cognitive decline. PARTICIPANTS Participants were 1629 people aged 65-84 years living in 13 communities in an urban area (Bunkyo-ku, Tokyo, Japan). Average age was 73.1±5.4 years. FINDINGS TO DATE We obtained baseline data on cognitive function, cerebral small vessel disease (SVD) determined by brain MRI, body composition, bone mineral density, arteriosclerosis, physical function, muscle mass, muscle strength and insulin sensitivity. Mild cognitive impairment and dementia were observed in 18.1% and 3.3% of participants, respectively. The prevalence of cerebral SVD was 24.8%. These characteristics are similar to those previously reported in elderly Japanese subjects. FUTURE PLANS We will ask participants about their health status, including incidence of cerebrovascular disease, falls, fractures and other diseases every year by mail. We plan to re-evaluate cognitive function, brain MRI parameters and other parameters at 5 and 10 years after the baseline evaluation. We will evaluate whether low muscle function (muscle mass, muscle strength or insulin sensitivity) is a risk factor for cognitive decline or cerebrovascular disease.
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Affiliation(s)
- Yuki Someya
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Juntendo University Graduate School of Health and Sports Science, Chiba, Japan
| | - Yoshifumi Tamura
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideyoshi Kaga
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Clinical Research Support Center, Juntendo University, Tokyo, Japan
| | - Kazunori Shimada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Miida
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Hirayama
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seiki Konishi
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yumiko Motoi
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Diagnosis, Prevention and Treatment of Dementia, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisashi Naito
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Juntendo University Graduate School of Health and Sports Science, Chiba, Japan
| | - Ryuzo Kawamori
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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15
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Kalaitzoglou E, Fowlkes JL, Popescu I, Thrailkill KM. Diabetes pharmacotherapy and effects on the musculoskeletal system. Diabetes Metab Res Rev 2019; 35:e3100. [PMID: 30467957 PMCID: PMC6358500 DOI: 10.1002/dmrr.3100] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022]
Abstract
Persons with type 1 or type 2 diabetes have a significantly higher fracture risk than age-matched persons without diabetes, attributed to disease-specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin-based therapies have shown divergent effects of different agents on fracture risk, including detrimental, beneficial, and neutral effects. The sulfonylurea class of drugs, owing to its hypoglycemic potential, is thought to amplify the risk of fall-related fractures, particularly in the elderly. Other agents such as the biguanides may, in fact, be osteo-anabolic. In contrast, despite similarly expected anabolic properties of insulin, data suggests that insulin pharmacotherapy itself, particularly in type 2 diabetes, may be a risk factor for fracture, negatively associated with determinants of bone quality and bone strength. Finally, sodium-dependent glucose co-transporter 2 inhibitors have been associated with an increased risk of atypical fractures in select populations, and possibly with an increase in lower extremity amputation with specific SGLT2I drugs. The role of skeletal muscle, as a potential mediator and determinant of bone quality, is also a relevant area of exploration. Currently, data regarding the impact of glucose lowering medications on diabetes-related muscle atrophy is more limited, although preclinical studies suggest that various hypoglycemic agents may have either aggravating (sulfonylureas, glinides) or repairing (thiazolidinediones, biguanides, incretins) effects on skeletal muscle atrophy, thereby influencing bone quality. Hence, the therapeutic efficacy of each hypoglycemic agent must also be evaluated in light of its impact, alone or in combination, on musculoskeletal health, when determining an individualized treatment approach. Moreover, the effect of newer medications (potentially seeking expanded clinical indication into the pediatric age range) on the growing skeleton is largely unknown. Herein, we review the available literature regarding effects of diabetes pharmacotherapy, by drug class and/or by clinical indication, on the musculoskeletal health of persons with diabetes.
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Affiliation(s)
- Evangelia Kalaitzoglou
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - John L Fowlkes
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Iuliana Popescu
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Kathryn M Thrailkill
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
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16
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Guan L, Gong D, Yang S, Shen N, Zhang S, Li Y, Wu Q, Yuan B, Sun Y, Dai N, Zhu L, Zou Y. Genipin ameliorates diet-induced obesity via promoting lipid mobilization and browning of white adipose tissue in rats. Phytother Res 2018; 32:723-732. [DOI: 10.1002/ptr.6022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/16/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Lili Guan
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Dezheng Gong
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Sirao Yang
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Nana Shen
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Sai Zhang
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Yuchen Li
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Qiong Wu
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Bo Yuan
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Yiping Sun
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Ning Dai
- Department of Gastroenterology; First Affiliated Hospital of Dalian Medical University; Dalian 116023 China
| | - Liang Zhu
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Yuan Zou
- Department of Physiology; Dalian Medical University; Dalian 116044 China
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17
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Zhang Y, Sun J, Li F, Grogan TR, Vergara JL, Luan Q, Park MS, Chia D, Elashoff D, Joshipura KJ, Wong DTW. Salivary extracellular RNA biomarkers for insulin resistance detection in hispanics. Diabetes Res Clin Pract 2017; 132:85-94. [PMID: 28802700 PMCID: PMC5741087 DOI: 10.1016/j.diabres.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/15/2016] [Accepted: 07/04/2017] [Indexed: 12/25/2022]
Abstract
AIMS Insulin resistance (IR) detection is challenging and no test is currently used in clinical practice. We developed salivary biomarkers that could be used for IR detection. METHODS We collected saliva from 186 healthy and 276 pre-diabetic participants, divided them into high and low IR groups based on a HOMA cutoff of 2.5. We profiled extracellular transcriptome by microarray in saliva supernatant from 23 high IR and 15 low IR participants, and pre-validated the top ten extracellular mRNA (exRNA) markers in a new cohort of 40 high and 40 low IR participants. A prediction panel was then built and validated in an independent cohort of 149 high and 195 low IR participants. RESULTS Transcriptomic analyses identified 42 exRNA candidates differentially present in saliva of high and low IR participants. From the top ten candidates, six were individually validated (PRKCB, S100A12, IL1R2, CAMP, VPS4B, CAP1) (p<0.01) and yielded AUC values ranging from 0.66 to 0.76. Body mass index (BMI) was significant higher in high compared to low IR group with AUC of 0.66, and showed no correlation with any of candidate biomarkers. The combination of four exRNA markers (IL1R2, VPS4B, CAP1, LUZP6) with BMI achieved excellent results in the prediction panel building dataset (AUC=0.79, sensitivity=79%, specificity=64%). The prediction model was validated in an independent cohort (AUC=0.82, sensitivity=63%, specificity=92%). CONCLUSIONS A panel of four salivary exRNA biomarkers (IL1R2, VPS4B, CAP1, LUZP6) and BMI was validated that can distinguish high and low IR participants, overall and in subgroups of healthy and pre-diabetic participants.
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Affiliation(s)
- Yong Zhang
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China; School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Jie Sun
- School of Medicine, Shenzhen University, Shenzhen, China; School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Feng Li
- School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Tristan R Grogan
- Department of Biostatistics and Medicine, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Jose L Vergara
- Center for Clinical Research and Health Promotion University of Puerto Rico School of Dental Medicine, San Juan, Puerto Rico
| | - QingXian Luan
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Moon-Soo Park
- Department of Oral Medicine and Diagnosis, Oral Science Institute, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea; School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - David Chia
- Department of Pathology, University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- Department of Biostatistics and Medicine, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Kaumudi J Joshipura
- Center for Clinical Research and Health Promotion University of Puerto Rico School of Dental Medicine, San Juan, Puerto Rico; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - David T W Wong
- School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.
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18
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Abstract
The prevalence of both type 2 diabetes and prediabetes increases with advancing age. The most important factors leading to hyperglycaemia are as follows: deficiency of insulin secretion developing with age, and growing insulin resistance caused by a change in body composition and sarcopaenia. Clinical features of diabetes in the elderly could be different. Diabetes in elderly people is often diagnosed with delay due to atypical symptoms (dementia, urinary incontinence) and occurrence of mainly postprandial hyperglycaemia. Elderly people are more exposed to diabetes complications, have more risk of myocardial infarction and end-stage renal disease, and are hospitalised more often due to hypoglycaemia than are younger patients. Elderly people with diabetes are a heterogeneous group with different life expectancy, concomitant of chronic diseases, and the ability to self-control blood glucose or give themselves an injection. The therapy should be individualised. Older people with long-term diabetes and numerous chronic complications need a more liberal approach to reach specific goals of therapy. Additional goals should be avoiding hypoglycaemia, safety of the therapy, and its acceptance by the patient.
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19
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Mitochondrial form, function and signalling in aging. Biochem J 2017; 473:3421-3449. [PMID: 27729586 DOI: 10.1042/bcj20160451] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 02/07/2023]
Abstract
Aging is often accompanied by a decline in mitochondrial mass and function in different tissues. Additionally, cell resistance to stress is frequently found to be prevented by higher mitochondrial respiratory capacity. These correlations strongly suggest mitochondria are key players in aging and senescence, acting by regulating energy homeostasis, redox balance and signalling pathways central in these processes. However, mitochondria display a wide array of functions and signalling properties, and the roles of these different characteristics are still widely unexplored. Furthermore, differences in mitochondrial properties and responses between tissues and cell types, and how these affect whole body metabolism are also still poorly understood. This review uncovers aspects of mitochondrial biology that have an impact upon aging in model organisms and selected mammalian cells and tissues.
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20
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Meal frequency patterns and glycemic properties of maternal diet in relation to preterm delivery: Results from a large prospective cohort study. PLoS One 2017; 12:e0172896. [PMID: 28249018 PMCID: PMC5332093 DOI: 10.1371/journal.pone.0172896] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/10/2017] [Indexed: 12/25/2022] Open
Abstract
Background Dietary habits are linked to high maternal glucose levels, associated with preterm delivery. The aim of this study was to examine the associations between meal frequency and glycemic properties of maternal diet in relation to preterm delivery. Methods This prospective cohort study included 66,000 women from the Norwegian Mother and Child Cohort Study (MoBa). Meal frequency and food intake data were obtained from a validated food frequency questionnaire during mid-pregnancy. Principal component factor analysis was used with a data-driven approach, and three meal frequency patterns were identified: “snack meal”, “main meal”, and “evening meal”. Pattern scores were ranked in quartiles. Glycemic index and glycemic load were estimated from table values. Intakes of carbohydrates, added sugar, and fiber were reported in grams per day and divided into quartiles. Gestational age was obtained from the Medical Birth Registry of Norway. Preterm delivery was defined as birth at <37 gestational weeks. A Cox regression model was used to assess associations with preterm delivery. Results After adjustments, the “main meal” pattern was associated with a reduced risk of preterm delivery, with hazard ratios (HRs) of 0.89 (95% confidence interval (CI): 0.80, 0.98) and 0.90 (95% CI: 0.81, 0.99) for the third and fourth quartiles, respectively, and p for trend of 0.028. This was mainly attributed to the group of women with BMI ≥25 kg/m2, with HRs of 0.87 (95% CI: 0.79, 0.96) and 0.89 (95% CI: 0.80, 0.98) for the third and fourth quartiles, respectively, and p for trend of 0.010. There was no association between glycemic index, glycemic load, carbohydrates, added sugar, fiber, or the remaining meal frequency patterns and preterm delivery. Conclusion Regular consumption of main meals (breakfast, lunch, dinner) was associated with a lower risk of preterm delivery. Diet should be further studied as potential contributing factors for preterm delivery.
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Huovinen V, Bucci M, Lipponen H, Kiviranta R, Sandboge S, Raiko J, Koskinen S, Koskensalo K, Eriksson JG, Parkkola R, Iozzo P, Nuutila P. Femoral Bone Marrow Insulin Sensitivity Is Increased by Resistance Training in Elderly Female Offspring of Overweight and Obese Mothers. PLoS One 2016; 11:e0163723. [PMID: 27669153 PMCID: PMC5036877 DOI: 10.1371/journal.pone.0163723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/09/2016] [Indexed: 12/25/2022] Open
Abstract
Bone marrow insulin sensitivity may be an important factor for bone health in addition to bone mineral density especially in insulin resistant conditions. First we aimed to study if prenatal maternal obesity plays a role in determining bone marrow insulin sensitivity in elderly female offspring. Secondly we studied if a four-month individualized resistance training intervention increases bone marrow insulin sensitivity in elderly female offspring and whether this possible positive outcome is regulated by the offspring’s mother’s obesity status. 37 frail elderly females (mean age 71.9 ± 3.1 years) of which 20 were offspring of lean/normal-weight mothers (OLM, maternal BMI ≤ 26.3 kg/m2) and 17 were offspring of obese/overweight mothers (OOM, maternal BMI ≥ 28.1 kg/m2) were studied before and after a four-month individualized resistance training intervention. Nine age- and sex-matched non-frail controls (maternal BMI ≤ 26.3 kg/m2) were studied at baseline. Femoral bone marrow (FBM) and vertebral bone marrow (VBM) insulin sensitivity were measured using [18F]fluoro-2-deoxy-D-glucose positron emission tomography with computer tomography under hyperinsulinemic euglycemic clamp. We found that bone marrow insulin sensitivity was not related to maternal obesity status but FBM insulin sensitivity correlated with whole body insulin sensitivity (R = 0.487, p = 0.001). A four-month resistance training intervention increased FBM insulin sensitivity by 47% (p = 0.006) only in OOM, while VBM insulin sensitivity remained unchanged regardless of the maternal obesity status. In conclusion, FBM and VBM glucose metabolism reacts differently to a four-month resistance training intervention in elderly women according to their maternal obesity status. TRIAL REGISTRATION ClinicalTrials.gov NCT01931540.
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Affiliation(s)
- Ville Huovinen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Marco Bucci
- Turku PET Centre, University of Turku, Turku, Finland
| | - Heta Lipponen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Riku Kiviranta
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Departments of Medicine and Medical Biochemistry and Genetics, University of Turku, Turku, Finland
| | - Samuel Sandboge
- Folkhälsan Research Centre, Helsinki, Finland
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland
| | - Juho Raiko
- Turku PET Centre, University of Turku, Turku, Finland
| | - Suvi Koskinen
- Turku PET Centre, University of Turku, Turku, Finland
| | | | - Johan G. Eriksson
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital Finland, Helsinki, Finland
| | - Riitta Parkkola
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Patricia Iozzo
- Turku PET Centre, University of Turku, Turku, Finland
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- * E-mail:
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Abstract
Introduction: In an aging population, new strategies are required to identify individuals at risk of adverse health outcomes. Frailty syndrome is related to negative health events. This increased risk may be used to identify individuals in which interventions can delay the onset of physical and functional complications. The aim of the study was to determine the relationship between the onset of frailty and the beginning of functional disability. Materials and Methods: This was a cross-sectional observational study with consecutive sampling to analyze 146 patients aged seventy and older who come to the primary care center. The level of frailty was registered according to fatigue, resistance, ambulation, illnesses, and loss of weight scale. Disability for Instrumental Activities of Daily Live dependency, comorbidity, and social risk factors was registered too. Results: The prevalence of frailty and prefrailty was 17.8% and 39%, respectively, and were associated with age, level of disability, and the presence of gastrointestinal disease. Prefrail patients had initial levels of dependency, while those who were not frail were mostly independent. Conclusion: Frailty syndrome is easily detectable. The intermediate stage known as prefrailty is related to the start of the functional disability. The syndrome screening identifies individuals at risk in whom we can potentially intervene to delay the onset of the syndrome and delay functional disability. Control of comorbidity in frail patients must be studied. Screening age could be set in patients between 75 and 81 years old.
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23
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The emergence of frailty and sarcopaenia in diabetes mellitus: description of inter-relationships and clinical importance. Cardiovasc Endocrinol 2016. [DOI: 10.1097/xce.0000000000000075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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24
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Liaw FY, Kao TW, Wu LW, Wang CC, Yang HF, Peng TC, Sun YS, Chang YW, Chen WL. Components of Metabolic Syndrome and the Risk of Disability among the Elderly Population. Sci Rep 2016; 6:22750. [PMID: 26948125 PMCID: PMC4780009 DOI: 10.1038/srep22750] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/19/2016] [Indexed: 12/19/2022] Open
Abstract
The direct relationship between metabolic syndrome (MetS) and function disability has not been established. The aim of the present study was to investigate the relationship between MetS and functional disability in the elderly. This retrospective observational study included 1,778 participants aged 60–84 years from the National Health and Nutrition Examination Survey (1999–2002). Impairments in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) were assessed. Additionally, the associations between the features of MetS and disability were evaluated. MetS was associated with a high prevalence of functional dependence in ADL, IADL, LSA, LEM, and GPA. After adjusting for potential confounders, a high number of MetS components was found to be associated with increased disability (P = 0.002). Additionally, associations were observed between MetS components, including abdominal obesity and high triglycerides levels, and functional dependence in ADL, IADL, LSA, LEM, and GPA (all, P < 0.05). A linear increase in disability might be associated with the number of MetS components in an elderly population. Additionally, MetS abnormalities, particularly abdominal obesity and high triglycerides levels, might be highly predictive of functional dependence in the elderly.
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Affiliation(s)
- Fang-Yih Liaw
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Chung-Ching Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Hui-Fang Yang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Tao-Chun Peng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Yu-Shan Sun
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Yaw-Wen Chang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C)
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan(R.O.C).,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan(R.O.C)
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Hashemipour S, Esmailzadehha N, Hamid H, Oveisi S, Yakhchaliha P, Ziaee A. Association of metabolic syndrome components with insulin resistance in normal weight population: the Qazvin Metabolic Diseases study. J Endocrinol Invest 2015; 38:1111-5. [PMID: 25952300 DOI: 10.1007/s40618-015-0302-y] [Citation(s) in RCA: 6] [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: 01/07/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Metabolically obese but normal weight (MONW) is associated with higher risk of type 2 diabetes, dyslipidemia, and hypertension. The aim of this study was to evaluate the association of metabolic syndrome components with MONW in each sex in Iranian population. METHODS This cross-sectional study was performed on 417 normal weight subjects in Qazvin, Iran between September 2010 and April 2011. MONW was defined by insulin resistance (IR) using the homeostatic model assessment (HOMA). Cut off point for IR was defined as the lower limit of top quintile of HOMA-IR values in normal weight population without any metabolic risk factors. Data were analyzed using T test, Mann-Whitney U test, and multi-variant logistic regression analysis. RESULTS Of 417 subjects, 44.3 % were female. The prevalence of MONW was 33.8 % in men and 39.8 % in women. Triglycerides levels were significantly higher in both men and women with MONW. Waist circumference was significantly higher in men with MONW, while high-density lipoprotein cholesterol levels were significantly lower in women with MONW. In logistic regression analysis, hypertriglyceridemia in women (OR 3.398; 95 % CI 1.306-8.846) and waist circumference (per 5 cm increment) in men (OR 1.653; 95 % CI 1.279-2.136) had independent association with MONW. CONCLUSION Association of metabolic syndrome components with MONW is different in men and women. Waist circumference had an independent association with IR in men but not in women. IR and its complications should be considered in lean women with hypertriglyceridemia.
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Affiliation(s)
- S Hashemipour
- Metabolic Diseases Research Center, Booali-Sina Hospital, Qazvin University of Medical Sciences, Booali-Sina Street, Qazvin, Iran
| | - N Esmailzadehha
- Metabolic Diseases Research Center, Booali-Sina Hospital, Qazvin University of Medical Sciences, Booali-Sina Street, Qazvin, Iran
| | - H Hamid
- Metabolic Diseases Research Center, Booali-Sina Hospital, Qazvin University of Medical Sciences, Booali-Sina Street, Qazvin, Iran
| | - S Oveisi
- Metabolic Diseases Research Center, Booali-Sina Hospital, Qazvin University of Medical Sciences, Booali-Sina Street, Qazvin, Iran
| | - P Yakhchaliha
- Metabolic Diseases Research Center, Booali-Sina Hospital, Qazvin University of Medical Sciences, Booali-Sina Street, Qazvin, Iran
| | - A Ziaee
- Metabolic Diseases Research Center, Booali-Sina Hospital, Qazvin University of Medical Sciences, Booali-Sina Street, Qazvin, Iran.
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Kwon OS, Tanner RE, Barrows KM, Runtsch M, Symons JD, Jalili T, Bikman BT, McClain DA, O'Connell RM, Drummond MJ. MyD88 regulates physical inactivity-induced skeletal muscle inflammation, ceramide biosynthesis signaling, and glucose intolerance. Am J Physiol Endocrinol Metab 2015; 309:E11-21. [PMID: 25968578 PMCID: PMC4490331 DOI: 10.1152/ajpendo.00124.2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/08/2015] [Indexed: 12/25/2022]
Abstract
Physical inactivity in older adults is a risk factor for developing glucose intolerance and impaired skeletal muscle function. Elevated inflammation and ceramide biosynthesis have been implicated in metabolic disruption and are linked to Toll-like receptor (TLR)/myeloid differentiation primary response 88 (MyD88) signaling. We hypothesize that a physical inactivity stimulus, capable of inducing glucose intolerance, would increase skeletal muscle inflammation and ceramide biosynthesis signaling and that this response would be regulated by the TLR/MyD88 pathway. Therefore, we subjected wild-type (WT) and MyD88(-/-) mice to hindlimb unloading (HU) for 14 days or an ambulatory control period. We observed impaired glucose uptake, muscle insulin signaling (p-Akt), and increased markers of NF-κB signaling (p-IκBα), inflammation (p-JNK, IL-6), TLR4, and the rate-limiting enzyme of ceramide biosynthesis, SPT2, with HU WT (P < 0.05), but not in HU MyD88(-/-) mice. Concurrently, we found that 5 days of bed rest in older adults resulted in whole body glucose dysregulation, impaired skeletal muscle insulin signaling, and upregulation of muscle IL-6 and SPT2 (P < 0.05). Post-bed rest TLR4 abundance was tightly correlated with impaired postprandial insulin and glucose levels. In conclusion, MyD88 signaling is necessary for the increased inflammation, ceramide biosynthesis signaling, and compromised metabolic function that accompanies physical inactivity.
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Affiliation(s)
| | | | | | | | - J David Symons
- Exercise and Sport Science and Divisions of Nutrition and Diabetes, Metabolism and Endocrinology, University of Utah, Salt Lake City, Utah; and
| | | | - Benjamin T Bikman
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah
| | - Donald A McClain
- Diabetes, Metabolism and Endocrinology, University of Utah, Salt Lake City, Utah; and
| | | | - Micah J Drummond
- Departments of Physical Therapy, Divisions of Nutrition and Diabetes, Metabolism and Endocrinology, University of Utah, Salt Lake City, Utah; and
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Ottum MS, Mistry AM. Advanced glycation end-products: modifiable environmental factors profoundly mediate insulin resistance. J Clin Biochem Nutr 2015; 57:1-12. [PMID: 26236094 PMCID: PMC4512899 DOI: 10.3164/jcbn.15-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/13/2015] [Indexed: 12/25/2022] Open
Abstract
Advanced glycation end-products are toxic by-products of metabolism and are also acquired from high-temperature processed foods. They promote oxidative damage to proteins, lipids and nucleotides. Aging and chronic diseases are strongly associated with markers for oxidative stress, especially advanced glycation end-products, and resistance to peripheral insulin-mediated glucose uptake. Modifiable environmental factors including high levels of refined and simple carbohydrate diets, hypercaloric diets and sedentary lifestyles drive endogenous formation of advanced glycation end-products via accumulation of highly reactive glycolysis intermediates and activation of the polyol/aldose reductase pathway producing high intracellular fructose. High advanced glycation end-products overwhelm innate defenses of enzymes and receptor-mediated endocytosis and promote cell damage via the pro-inflammatory and pro-oxidant receptor for advanced glycation end-products. Oxidative stress disturbs cell signal transduction, especially insulin-mediated metabolic responses. Here we review emerging evidence that restriction of dietary advanced glycation end-products significantly reduces total systemic load and insulin resistance in animals and humans in diabetes, polycystic ovary syndrome, healthy populations and dementia. Of clinical importance, this insulin sensitizing effect is independent of physical activity, caloric intake and adiposity level.
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Affiliation(s)
- Mona S Ottum
- Dietetics and Human Nutrition Program, 318 Marshall Building, Eastern Michigan University, Ypsilanti, MI 48197, USA
| | - Anahita M Mistry
- Dietetics and Human Nutrition Program, 318 Marshall Building, Eastern Michigan University, Ypsilanti, MI 48197, USA
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Zuliani G, Soavi C, Maggio M, De Vita F, Cherubini A, Volpato S. Counteracting inflammation and insulin resistance with diet and exercise: A strategy for frailty prevention? Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Diabetes in ageing communities imposes a substantial personal and public health burden by virtue of its high prevalence, its capacity to cause disabling vascular complications, the emergence of new non-vascular complications, and the effects of frailty. In this Review, we examine the current state of knowledge about diabetes in older people (aged ≥ 75 years) and discuss how recognition of the effect of frailty and disability is beginning to lead to new management approaches. A multidimensional and multidisciplinary assessment process is essential to obtain information on medical, psychosocial, and functional capabilities, and also on how impairments of these functions could limit activities. Major aims of diabetes care include maintenance of independence, functional status, and quality of life by reduction of symptom and medicine burden, and active identification of risks. Linking of therapeutic targets to individual functional status is mandatory and very tight glucose control is often not necessary. Hypoglycaemia remains an important avoidable iatrogenic event. Quality diabetes care in older people remains an important challenge for health professionals.
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Affiliation(s)
- Alan Sinclair
- Diabetes Frail, Hampton Lovett, Droitwich, Worcestershire, UK.
| | - Trisha Dunning
- Centre for Nursing and Allied Health Research at Deakin University, VIC, Australia; Barwon Health, VIC, Australia
| | - Leocadio Rodriguez-Mañas
- Department of Geriatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain; School of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
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Abstract
PURPOSE OF REVIEW There is an increasing number of reports suggesting that indicators of obesity for the general adult population may need to be modified; that the magnitude of risk is attenuated or that adiposity may even be protective; and that additional adverse outcomes specific to older persons need to be considered. Finally, there are benefits and adverse effects of weight loss programmes for older persons. This article reviews publications addressing these issues from 2013 to March 2014. RECENT FINDINGS BMI was not considered to be as good an indicator of obesity because of loss of muscle mass with age. Higher body weight seems to be protective among older persons with chronic diseases or geriatric syndromes. Increased adiposity together with decreased muscle mass (sarcopenic obesity) is associated with adverse outcomes, although there is no consensus regarding the definition. Intentional weight loss has health benefits but is accompanied by muscle and bone loss, and therefore programmes should include components to counteract these changes. SUMMARY The magnitude of health risk associated with obesity is attenuated with age, and mild increase in adiposity may be beneficial for those who are frail and/or with chronic diseases. Weight loss programmes should include resistance exercises to counteract muscle loss.
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Affiliation(s)
- J Woo
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Lang PO, Trivalle C, Vogel T, Proust J, Papazyan JP, Dramé M. Determination of Cutoff Values for DEXA-Based Body Composition Measurements for Determining Metabolic and Cardiovascular Health. Biores Open Access 2015; 4:16-25. [PMID: 26309779 PMCID: PMC4497664 DOI: 10.1089/biores.2014.0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The two components of the body weight (i.e., fat mass and muscle mass) appeared to be of high interest to consider in predicting metabolic health related risks. We aimed to determine cutoff values for fat mass index (FMI) and muscle mass index (MMI), FM/MM, and BMI for metabolic and cardiovascular health. This study was a cross-sectional analysis study conducted in a center of preventive medicine. It included 616 consecutive outpatients: mean age was 56.0±10.0 years (74.6% aged ≥50), and 61.4% were female. Fat and muscle mass were obtained with dual energy X-ray absorptiometry scan analyses. Metabolically unhealthy individuals were defined as people with biological features of dyslipidemia, hyperuricemia, diabetes, and/or hepatitis steatosis. Documented hypertension and/or atherosclerosis of at least one major artery defined individuals with cardiovascular complications. Receiver-operating characteristic curve analysis revealed that the cutoff values for MMI, FMI, and FM/MM were respectively 18.8kg/m2 (sensitivity [Se]=58%; specificity [Sp]=59%), 5.5kg/m2 (Se=61%; Sp=62%), and 0.31 (Se=62%; Sp=62%) in men; and 14.1kg/m2 (Se=52%; Sp=54%), 5.5kg/m2 (Se=65%; Sp=67%), 0.39 (Se=73%; Sp=73%) in women for predicting metabolic health. Values were 19.3kg/m2 (Se=58%; Sp=59%), 7.0kg/m2 (Se=61%; Sp=62%) and 0.49 (Se=62%; Sp=62%) in men; and 15.7kg/m2 (Se=58%; Sp=59%), 6.4kg/m2 (Se=61%; Sp=62%) and 0.35 (Se=62%; Sp=62%) in women for cardiovascular complications. Whatever the outcomes considered, the Youden indexes for BMI values were systematically below 25 kg/m2, except for cardiovascular complications in men, where the threshold for the best Se/Sp was 25.7 kg/m2. These cutoff values for FMI, MMI, and FM/MM could be of practical value for the clinical evaluation of a deficit in MM with or without excess of FM. They complement the classical concept of BMI in a more qualitative manner and extend the analysis of its impact on health outcomes to all BMI categories.
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Affiliation(s)
- Pierre-Olivier Lang
- Health and Wellbeing Academy, Anglia Ruskin University , Cambridge, United Kingdom . ; Nescens Centre of Preventive Medicine, Clinic of Genolier , Genolier, Switzerland
| | - Christophe Trivalle
- Pôle Gériatrie, Hôpitaux Universitaires de Paris-Sud , Hôpital Paul Brousse, Assistance-Publique Hôpitaux de Paris, Villejuif, France
| | - Thomas Vogel
- Pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg , Strasbourg, France
| | - Jacques Proust
- Nescens Centre of Preventive Medicine, Clinic of Genolier , Genolier, Switzerland
| | | | - Moustapha Dramé
- Department of Research and Innovation, Hôpitaux Universitaires de Reims , Reims, France . ; Faculty of Medicine, University of Reins-Champagne-Ardenne , Reins, France
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Sakurai T, Kawashima S, Satake S, Miura H, Tokuda H, Toba K. Differential subtypes of diabetic older adults diagnosed with Alzheimer's disease. Geriatr Gerontol Int 2014; 14 Suppl 2:62-70. [PMID: 24650067 DOI: 10.1111/ggi.12250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2013] [Indexed: 12/25/2022]
Abstract
AIM The clinical management of diabetic elderly patients with Alzheimer's disease (AD) is hindered by several difficulties. The present study aimed to clarify the clinical characteristics and pathophysiological properties of AD in diabetic older adults. METHODS A total of 91 patients with type 2 diabetes mellitus and 161 non-diabetic individuals who were diagnosed with AD were recruited. Diabetic patients were classified into two groups with glycated hemoglobin (HbA1c) < 7.0% or ≥ 7.0%. The demographics, cognition, daily-life function, metabolic changes, treatment, and behavioral and psychological symptoms of dementia (BPSD), as well as brain pathophysiology, were compared among the three groups. RESULTS Patients with higher HbA1c had increased diabetic vascular complications and impaired activities of daily living with decreased levels of serum high-molecular-weight adiponectin and 25-hydroxyvitamin D. Although cognitive status was similar among the three groups, BPSD, including apathy, overeating and excessive daytime sleeping appeared to be increased in the patients with HbA1c ≥ 7.0%. The frequency of apolipoprotein E4 carriers and of posterior cerebral hypoperfusion (AD-pattern) on single-photon emission computed tomography in poorly controlled diabetic subjects was similar to that in non-diabetic AD patients, whereas diabetic patients with HbA1c <7.0% included fewer apolipoprotein E4 carriers and fewer patients with an AD pattern on single-photon emission computed tomography. CONCLUSION Subtypes of older diabetic patients with AD were identified based on clinical features and brain pathophysiology. Physical and psychological complications of dementia are prevalent in patients with higher HbA1c. It seems likely that difficulties in the management of diabetes with AD are due not only to non-adherence to diabetes treatment, but also several symptoms and pathophysiological characteristics of dementia.
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Affiliation(s)
- Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders
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Hyperinsulinemia is associated with the loss of appendicular skeletal muscle mass at 4.6 year follow-up in older men and women. Clin Nutr 2014; 34:931-6. [PMID: 25453394 DOI: 10.1016/j.clnu.2014.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 09/01/2014] [Accepted: 09/29/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Homeostasis model assessment as a marker of insulin resistance has been associated with the pronounced loss of appendicular skeletal muscle mass in older adults. In the present study, we hypothesized that hyperinsulinemia as an early predictor of insulin resistance may be associated with the loss of appendicular skeletal muscle mass (ASM). METHODS This is a cohort study that included 147 well-functioning older men and women subjects who were followed for a period of 4.6 ± 1.8 years. Lean tissue in arm and legs, or ASM, was derived from dual-energy X-ray absorptiometry at baseline with follow-up measurements to obtain the relative change. Hyperinsulinemia was defined empirically at the 75th percentile. RESULTS The relative change in ASM was negative and significant throughout the quartiles of fasting insulin levels (p ≤ 0.05); however, the loss of ASM was more pronounced in the later quartiles (-0.7 kg) compared with the relative change in Q1 and Q2 (-0.5 kg and -0.3 kg). The unadjusted analysis indicates a significant association between hyperinsulinemia and the loss of ASM (β = -0.28, 95% CI-0.57-0.009, p = 0.05), an association that remained significant after adjusting for several covariates. CONCLUSION Hyperinsulinemia as an early marker of insulin resistance was associated with the loss of ASM in a cohort study of community-dwelling older men and women subjects without other chronic health conditions. The use of fasting insulin levels >8.4 μU/mL may help clinicians identify individuals in the geriatric population who are at a high risk of loss of appendicular skeletal muscle mass.
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Dardano A, Penno G, Del Prato S, Miccoli R. Optimal therapy of type 2 diabetes: a controversial challenge. Aging (Albany NY) 2014; 6:187-206. [PMID: 24753144 PMCID: PMC4012936 DOI: 10.18632/aging.100646] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/24/2014] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is one of the most common chronic disorders in older adults and the number of elderly diabetic subjects is growing worldwide. Nonetheless, the diagnosis of T2DM in elderly population is often missed or delayed until an acute metabolic emergency occurs. Accumulating evidence suggests that both aging and environmental factors contribute to the high prevalence of diabetes in the elderly. Clinical management of T2DM in elderly subjects presents unique challenges because of the multifaceted geriatric scenario. Diabetes significantly lowers the chances of "successful" aging, notably it increases functional limitations and impairs quality of life. In this regard, older diabetic patients have a high burden of comorbidities, diabetes-related complications, physical disability, cognitive impairment and malnutrition, and they are more susceptible to the complications of dysglycemia and polypharmacy. Several national and international organizations have delivered guidelines to implement optimal therapy in older diabetic patients based on individualized treatment goals. This means appreciation of the heterogeneity of the disease as generated by life expectancy, functional reserve, social support, as well as personal preference. This paper will review current treatments for achieving glycemic targets in elderly diabetic patients, and discuss the potential role of emerging treatments in this patient population.
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Affiliation(s)
- Angela Dardano
- Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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Genipin ameliorates age-related insulin resistance through inhibiting hepatic oxidative stress and mitochondrial dysfunction. Exp Gerontol 2013; 48:1387-94. [PMID: 24041487 DOI: 10.1016/j.exger.2013.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/06/2013] [Accepted: 09/09/2013] [Indexed: 12/25/2022]
Abstract
Insulin resistance (IR) increases with age and plays a key role in the pathogenesis of type 2 diabetes mellitus. Oxidative stress and mitochondrial dysfunction are supposed to be major factors leading to age-related IR. Genipin, an extract from Gardenia jasminoides Ellis fruit, has been reported to stimulate insulin secretion in pancreatic islet cells by regulating mitochondrial function. In this study, we first investigated the effects of genipin on insulin sensitivity and the potential mitochondrial mechanisms in the liver of aging rats. The rats were randomly assigned to receive intraperitoneal injections of either 25mg/kg genipin or vehicle once daily for 12days. The aging rats showed hyperinsulinemia and hyperlipidemia, and insulin resistance as examined by the decreased glucose decay constant rate during insulin tolerance test (kITT). The hepatic tissues showed steatosis and reduced glycogen content. Hepatic malondialdehyde level and mitochondrial reactive oxygen species (ROS) were higher, and levels of mitochondrial membrane potential (MMP) and ATP were lower as compared with the normal control rats. Administration of genipin ameliorated systemic and hepatic insulin resistance, alleviated hyperinsulinemia, hyperglyceridemia and hepatic steatosis, relieved hepatic oxidative stress and mitochondrial dysfunction in aging rats. Furthermore, genipin not only improved insulin sensitivity by promoting insulin-stimulated glucose consumption and glycogen synthesis, inhibited cellular ROS overproduction and alleviated the reduction of levels of MMP and ATP, but also reversed oxidative stress-associated JNK hyperactivation and reduced Akt phosphorylation in palmitate-treated L02 hepatocytes. In conclusion, genipin ameliorates age-related insulin resistance through inhibiting hepatic oxidative stress and mitochondrial dysfunction.
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Gungor O, Kircelli F, Voroneanu L, Covic A, Ok E. Hormones and Arterial Stiffness in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2013; 20:698-707. [DOI: 10.5551/jat.18580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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