1
|
Mandal N, Stentz F, Asuzu PC, Nyenwe E, Wan J, Dagogo-Jack S. Plasma Sphingolipid Profile of Healthy Black and White Adults Differs Based on Their Parental History of Type 2 Diabetes. J Clin Endocrinol Metab 2024; 109:740-749. [PMID: 37804534 PMCID: PMC10876402 DOI: 10.1210/clinem/dgad595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
CONTEXT Ceramides and sphingolipids have been linked to type 2 diabetes (T2D). The Ceramides and Sphingolipids as Predictors of Incident Dysglycemia (CASPID) study is designed to determine the association of plasma sphingolipids with the pathophysiology of human T2D. OBJECTIVE A comparison of plasma sphingolipids profiles in Black and White adults with (FH+) and without (FH-) family history of T2D. DESIGN We recruited 100 Black and White FH- (54 Black, 46 White) and 140 FH+ (75 Black, 65 White) adults. Fasting plasma levels of 58 sphingolipid species, including 18 each from 3 major classes (ceramides, monohexosylceramides, and sphingomyelins, all with 18:1 sphingoid base) and 4 long-chain sphingoid base-containing species, were measured by liquid chromatography/mass spectrometry. RESULTS Sphingomyelin was the most abundant sphingolipid in plasma (89% in FH-), and was significantly elevated in FH+ subjects (93%). Ceramides and monohexosylceramides comprised 5% and 6% of total sphingolipids in the plasma of FH- subjects, and were reduced significantly in FH+ subjects (3% and 4%, respectively). In FH+ subjects, most ceramide and monohexosylceramide species were decreased but sphingomyelin species were increased. The level of C18:1 species of all 3 classes was elevated in FH+ subjects. CONCLUSION Elevated levels of sphingomyelin, the major sphingolipids of plasma, and oleic acid-containing sphingolipids in healthy FH+ subjects compared with healthy FH- subjects may reflect heritable elements linking sphingolipids and the development of T2D.
Collapse
Affiliation(s)
- Nawajes Mandal
- Departments of Ophthalmology, Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Research, Memphis VA Medical Center, Memphis, TN 38104, USA
| | - Frankie Stentz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Peace Chiamaka Asuzu
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Ebenezer Nyenwe
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jim Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- General Clinical Research Center, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| |
Collapse
|
2
|
Park JS, Cho SR, Yim JE. Resting energy expenditure in Korean type 2 diabetes patients: comparison between measured and predicted values. Nutr Res Pract 2023; 17:464-474. [PMID: 37266123 PMCID: PMC10232204 DOI: 10.4162/nrp.2023.17.3.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND/OBJECTIVES Estimation of energy demand using resting energy expenditure (REE) is a reasonable approach for optimizing glycemic control and weight management in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare REE predictions and objective measurements in patients with T2DM in Korea. SUBJECTS/METHODS This study enrolled 36 participants with T2DM (age range, 20-60 years). Anthropometric variables including height, weight, waist-hip ratio, blood pressure, body fat, body fat percentage, and total body weight were measured using bioimpedance. REE was evaluated using indirect calorimetry. The measured REE values were compared to values estimated using five predictive equations: the Harris-Benedict, Mifflin, Owen, Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO), and Schofield equations. This study evaluated the associations between measured REE values and anthropometric/clinical data, including height, weight, and age, using multivariate linear regression. RESULTS The mean measured REE value was 1891.79 ± 288.03 kcal/day (male), 1,502.00 ± 202.96 kcal/day (female). REE estimates generated from the Mifflin equation showed the largest differences from measured REE values, whereas estimates derived from the FAO/WHO equation were the closest to the measured REE values. This study also identified associations between measured REE values and various anthropometric/clinical variables. CONCLUSION The accuracy of REE prediction equations is critically important in promoting the efficacy of dietary counseling and the effective treatment of diabetes. Our results indicate the need for additional studies informing more suitable methods for determining the energy requirements of Korean patients with T2DM.
Collapse
Affiliation(s)
- Ji-Sook Park
- Department of Food and Nutrition, Changwon National University, Changwon 51140, Korea
| | - Sung-Rae Cho
- Department of Endocrinology, Changwon Fatima Hospital, Changwon 51394, Korea
| | - Jung-Eun Yim
- Department of Food and Nutrition, Changwon National University, Changwon 51140, Korea
- Interdisciplinary Program in Senior Human Ecology, Changwon National University, Changwon 51140, Korea
| |
Collapse
|
3
|
Finocchio T, Surbhi S, Madlock-Brown C. Time to Development of Overt Diabetes and Macrovascular and Microvascular Complications Among Patients With Prediabetes: A Retrospective Cohort Study. Cureus 2021; 13:e20079. [PMID: 34987939 PMCID: PMC8719530 DOI: 10.7759/cureus.20079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/15/2022] Open
Abstract
Objective In this study, we aimed to determine the effect of age, gender, race, and obesity on the development of overt diabetes and macro/microvascular events among patients with prediabetes. Methods This was a retrospective cohort study of patient records available through a national electronic health record (EHR) database from 2012 to 2017. Patients with prediabetes in the baseline year of 2012 were identified. Macro/microvascular events were defined as the diagnosis of myocardial infarction (MI), stroke, or chronic kidney disease (CKD). The effects of age, gender, race, and obesity on the incidence of diabetes and macro/microvascular events between 2013-2017 were assessed using the multivariate Cox proportional-hazards model. Results Among the total 5,230 patients with prediabetes in 2012, 16.7% developed overt diabetes, and 19.7% developed a macro/microvascular event. Elderly patients (HR: 2.96, 95% CI: 2.12-4.13), males (HR: 1.38, 95% CI: 1.20-1.59), and African-Americans (HR: 1.47, 95% CI: 1.26-1.73) were at a higher risk of experiencing a macro/microvascular event. Additionally, male gender (HR: 1.27, 95% CI: 1.11-1.46) and obesity (HR: 1.24, 95% CI: 1.08-1.43) were significant factors associated with the development of overt diabetes. Furthermore, when diabetes status was added as an interaction term to the Cox proportional-hazards model, no statistical difference was found with respect to any of the other independent variables. It can therefore be inferred that those with prediabetes and overt diabetes had a similar risk of developing macro/microvascular events. Conclusions Based on our findings, factors including advanced age, obesity, male gender, and African race significantly impact the progression to diabetes and associated macro/microvascular events.
Collapse
Affiliation(s)
- Tyler Finocchio
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, USA
| | - Satya Surbhi
- Department of General Internal Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, USA
| | - Charisse Madlock-Brown
- Health Informatics and Information Management, The University of Tennessee Health Science Center, Memphis, USA
| |
Collapse
|
4
|
Amador M, Meza CA, McAinch AJ, King GA, Covington JD, Bajpeyi S. Exercise-Induced Improvements in Insulin Sensitivity Are Not Attenuated by a Family History of Type 2 Diabetes. Front Endocrinol (Lausanne) 2020; 11:120. [PMID: 32231642 PMCID: PMC7088124 DOI: 10.3389/fendo.2020.00120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/24/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction: A family history of type 2 diabetes (FH+) is a major risk factor for the development of insulin resistance and type 2 diabetes. However, it remains unknown whether exercise-induced improvements in insulin sensitivity and metabolic flexibility are impacted by a FH+. Therefore, we investigated whether improvements in insulin sensitivity, metabolic flexibility, body composition, aerobic fitness and muscle strength are limited by a FH+ following eight weeks of combined exercise training compared to individuals without a family history of type 2 diabetes (FH-). Methods: Twenty (n = 10 FH-, n = 10 FH+) young, healthy, sedentary, normoglycemic, Mexican-American males (age: FH- 22.50 ± 0.81, FH+ 23.41 ± 0.86 years; BMI: FH- 27.91 ± 1.55, FH+ 26.64 ± 1.02 kg/m2) underwent eight weeks of combined aerobic and resistance exercise training three times/week (35 min aerobic followed by six full-body resistance exercises). Insulin sensitivity was assessed via hyperinsulinemic euglycemic clamps. Metabolic flexibility was assessed by the change in respiratory quotient from fasted to insulin-stimulated states. Body composition was determined using dual-energy x-ray absorptiometry. Aerobic fitness was determined by a graded exercise test, and upper- and lower-body strength were assessed via one-repetition maximum bench press and leg strength dynamometer, respectively. Results: Insulin sensitivity, metabolic flexibility, aerobic fitness and strength were not different between groups (p > 0.05). Eight weeks of combined aerobic and resistance exercise training improved insulin sensitivity (FH- p = 0.02, FH+ p = 0.002), increased fat free mass (FH- p = 0.006, FH+ p = 0.001), aerobic fitness (FH- p = 0.03, FH+ p = 0.002), and upper- (FH- p = 0.0001, FH+ p = 0.0001) and lower-body strength (FH- p = 0.0009, FH+ p = 0.0003), but did not change metabolic flexibility (p > 0.05) in both groups. Exercise-induced improvements in metabolic outcomes were similar between groups. Conclusions: Insulin sensitivity, metabolic flexibility, aerobic fitness and strength were not compromised by a FH+. Additionally, a FH+ is not a limiting factor for exercise-induced improvements in insulin sensitivity, aerobic fitness, body composition, and strength in normoglycemic young Mexican-American men.
Collapse
Affiliation(s)
- Manuel Amador
- Metabolic, Nutrition and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, TX, United States
| | - Cesar A. Meza
- Metabolic, Nutrition and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, TX, United States
| | - Andrew J. McAinch
- Institute for Health and Sport, College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science, Victoria University, Melbourne, VIC, Australia
| | - George A. King
- Metabolic, Nutrition and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, TX, United States
| | - Jeffrey D. Covington
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, United States
| | - Sudip Bajpeyi
- Metabolic, Nutrition and Exercise Research (MiNER) Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, TX, United States
- *Correspondence: Sudip Bajpeyi
| |
Collapse
|
5
|
Lu J, Zhang Y, Dong X, Lu J, Zhang C, Liu J, Yu Q, Teng H, Yao Q, Yin J, Qin L. Association between MIC-1 and Type 2 Diabetes: A Combined Analysis. DISEASE MARKERS 2019; 2019:7284691. [PMID: 31827641 PMCID: PMC6885201 DOI: 10.1155/2019/7284691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/23/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Type 2 diabetes mellitus (T2DM) is an epidemic disease that endangers human health seriously. Recently, a large number of reports have revealed that macrophage-inhibiting cytokine-1 (MIC-1) is linked with T2DM, but the results were inconclusive. The aim of this study was to perform bioinformatics analysis of the association between MIC-1 and T2DM. MATERIAL AND METHODS Datasets and relevant literatures were searched in Gene Expression Omnibus (GEO), PubMed, Google Scholar, and Web of Science till September 20, 2019. Expression levels of MIC-1 were extracted, pooled, and compared between T2DM cases and controls. RESULTS In summary, 11 GEO datasets and 3 articles with 421 T2DM cases and 711 controls were finally included. The expression level of MIC-1 was significantly higher in T2DM patients compared with controls, with a standard mean difference (SMD) of 0.54 and a 95% confidence interval (95% CI) of 0.24-0.83; in blood samples, the difference was still significant (SMD = 0.65; 95%CI = 0.24-1.06). Meanwhile, the expression level of MIC-1 plays a significant role in differentiating T2DM cases from controls; the combined sensitivity, specificity, and odds ratio were 0.83 (95%CI = 0.72-0.90), 0.59 (95%CI = 0.45-0.72), and 1.64 (95%CI = 1.35-1.99), respectively. The summary receiver operating characteristic (SROC) curve demonstrated that the area under the curve (AUC) was 0.81 (95%CI = 0.77-0.84). CONCLUSION Our results suggested that the expression levels of MIC-1 were significantly higher in T2DM patients in multiple tissues including blood samples.
Collapse
Affiliation(s)
- Jianan Lu
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Yue Zhang
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Xingxuan Dong
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Jiawen Lu
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Chen Zhang
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Jieyu Liu
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Qingzhou Yu
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Haoyue Teng
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Qingkui Yao
- Community Health Service Center of Minglou, Subdistrict Jiangdong District, Ningbo, China
| | - Jieyun Yin
- Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou, China
| | - Liqiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| |
Collapse
|
6
|
Agbim U, Carr RM, Pickett-Blakely O, Dagogo-Jack S. Ethnic Disparities in Adiposity: Focus on Non-alcoholic Fatty Liver Disease, Visceral, and Generalized Obesity. Curr Obes Rep 2019; 8:243-254. [PMID: 31144261 PMCID: PMC6662200 DOI: 10.1007/s13679-019-00349-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Excessive adiposity has become a public health problem worldwide, contributing to the rise in obesity-related diseases and associated morbidity and mortality. This review details the relative significance of race/ethnicity as it pertains to adiposity and non-alcoholic fatty liver disease (NAFLD). RECENT FINDINGS Fat distribution remains a more reliable measure of adiposity than anthropometric measures, with visceral adipose tissue (VAT) associated with increased risk of cardiometabolic disease. While obesity is the most common risk factor for NAFLD, the racial/ethnic prevalence of obesity does not completely parallel NAFLD risk. Combating racial/ethnic disparities in obesity requires understanding differential risk among various groups. Hispanics are disproportionally impacted by NAFLD and have high rates of obesity, VAT, and insulin resistance (IR). This contrasts with Blacks, who have high prevalence of obesity and IR, accompanied by a paradoxically favorable lipid profile and low prevalence of VAT and NAFLD. Many features of adiposity and NAFLD are mediated by genetic and environmental factors, the latter being modifiable and the focus of interventions.
Collapse
Affiliation(s)
- Uchenna Agbim
- Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rotonya M Carr
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Octavia Pickett-Blakely
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sam Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Tennessee Health Science Center, 920 Madison Avenue, Suite 300A, Memphis, TN, 38163, USA.
| |
Collapse
|
7
|
Morino K, Kondo K, Tanaka S, Nishida Y, Nakae S, Yamada Y, Ugi S, Fuse K, Miyazawa I, Ohi A, Nishida K, Kurihara M, Sasaki M, Ebine N, Sasaki S, Katsukawa F, Maegawa H. Total energy expenditure is comparable between patients with and without diabetes mellitus: Clinical Evaluation of Energy Requirements in Patients with Diabetes Mellitus (CLEVER-DM) Study. BMJ Open Diabetes Res Care 2019; 7:e000648. [PMID: 31114702 PMCID: PMC6501857 DOI: 10.1136/bmjdrc-2019-000648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Assessment of total energy expenditure (TEE) is essential for appropriate recommendations regarding dietary intake and physical activity in patients with and without diabetes mellitus (DM). However, few reports have focused on TEE in patients with DM, particularly in Asian countries. Therefore, we evaluated TEE in Japanese patients with DM using the doubly labeled water (DLW) method and physical activity level (PAL). RESEARCH DESIGN AND METHODS In this cross-sectional observational study, we evaluated 52 patients with type 2 DM and 15 patients without DM. Free-living TEE was measured over 12-16 days by the DLW method, and PAL was calculated as TEE divided by the basal metabolic rate (BMR) as assessed by indirect calorimetry. The equivalence margin was defined as 5 kcal/kg/day. RESULTS The numbers of patients with DM treated with insulin, oral antidiabetic drugs, and diet were 18 (34.6%), 20 (38.5%), and 14 (26.9%), respectively. The mean±SD level of glycated hemoglobin was 6.9%±0.8% and 5.5%±0.3% in the DM and non-DM group, respectively (p<0.001). The mean body mass index was 23.3±3.0 and 22.7±2.1 kg/m2 in the DM and non-DM group, respectively. The mean TEE per kilogram body weight adjusted for sex and age was 36.5 kcal/kg/day and 37.5 kcal/kg/day in the DM and non-DM group, respectively, with no significant difference (mean difference, -1.0 kcal/kg/day; 95% CI -4.2 to 2.3 kcal/kg/day). The BMR tended to be higher in the DM than in the non-DM group (mean difference, 33 kcal/day; 95% CI, -15 to 80 kcal/day). The mean PAL adjusted for sex and age was 1.71 and 1.81 in the DM and non-DM group, respectively, without a significant difference (mean difference, -0.10; 95% CI -0.21 to 0.01). CONCLUSION TEE was comparable between Japanese patients with and without DM. TRIAL REGISTRATION NUMBER UMIN000023051.
Collapse
Affiliation(s)
- Katsutaro Morino
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Shigeho Tanaka
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Yuki Nishida
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Satoshi Nakae
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Yosuke Yamada
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Satoshi Ugi
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Keiko Fuse
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Akiko Ohi
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
| | - Kaori Nishida
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
| | - Mika Kurihara
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
| | - Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
| | - Naoyuki Ebine
- Faculty of Health and Sports Science, Doshisha University, Kyotanabe, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, The University of Tokyo, Tokyo, Japan
| | | | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| |
Collapse
|